WorldWideScience

Sample records for center disaster outcome

  1. Overview of Findings from the World Trade Center Disaster Outcome Study: Recommendations for Future Research after Exposure to Psychological Trauma

    OpenAIRE

    Boscarino, Joseph A.; Adams, Richard E.

    2008-01-01

    In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a prospective cohort study of 2,368 New York City (NYC) adults funded by the National Institutes of Health after the September 11 attacks. The findings reported were based on a baseline survey conducted one year after the disaster and a follow-up conducted two years post-disaster. One of the goals of this research was to assess the effectiveness of post-disaster treatments received by NYC residents ...

  2. Overview of findings from the World Trade Center Disaster Outcome Study: recommendations for future research after exposure to psychological trauma.

    Science.gov (United States)

    Boscarino, Joseph A; Adams, Richard E

    2008-01-01

    In this article we review findings from the World Trade Center Disaster (WTCD) Outcomes Study, a prospective cohort study of 2,368 New York City (NYC) adults funded by the National Institutes of Health after the September 11 attacks. The findings reported were based on a baseline survey conducted one year after the disaster and a follow-up conducted two years post-disaster. One of the goals of this research was to assess the effectiveness of post-disaster treatments received by NYC residents following the attacks. Among the major findings of this study were the relatively small increase in mental health service utilization and the fact that only brief worksite interventions seemed to be an effective post-disaster treatment intervention. Specifically, those who received more conventional post-disaster interventions, such as formal psychotherapy sessions and/or psychotropic medicines, seemed to have poorer outcomes. Since this study was designed to assess treatment outcomes, use advanced measurement techniques, and incorporate propensity score matching to control for bias, these treatment findings were unexpected and raised clinical questions. Additional findings were also discussed related to minority group members, alcohol abuse, the onset and course of posttraumatic stress disorder post-disaster and other findings. Future research is recommended to resolve the issues raised by this important study, especially as this relates to treatment outcomes.

  3. FEMA Disaster Recovery Centers

    Data.gov (United States)

    Department of Homeland Security — This is a search site for FEMA's Disaster Recovery Centers (DRC). A DRC is a readily accessible facility or mobile office set up by FEMA where applicants may go for...

  4. FEMA Disaster Recovery Centers - KML

    Data.gov (United States)

    Department of Homeland Security — This is a KML file for FEMA's Disaster Recovery Centers (DRC). A DRC is a readily accessible facility or mobile office set up by FEMA where applicants may go for...

  5. Emergency Preparedness Safety Climate and Other Factors Associated With Mental Health Outcomes Among World Trade Center Disaster Evacuees.

    Science.gov (United States)

    Sherman, Martin F; Gershon, Robyn R; Riley, Halley E M; Zhi, Qi; Magda, Lori A; Peyrot, Mark

    2017-06-01

    We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation. We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder. After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower "emergency preparedness safety climate" scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress. Improving the "emergency preparedness safety climate" of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326-336).

  6. Epidemiology of respiratory health outcomes among World Trade Center disaster workers: review of the literature 10 years after the September 11, 2001 terrorist attacks.

    Science.gov (United States)

    Ekenga, Christine C; Friedman-Jiménez, George

    2011-09-01

    Tens of thousands of workers participated in rescue, recovery, and cleanup activities at the World Trade Center (WTC) site in lower Manhattan after the terrorist attacks on September 11, 2001 (9/11). The collapse of the WTC resulted in the release of a variety of airborne toxicants. To date, respiratory symptoms and diseases have been among the most examined health outcomes in studies of WTC disaster workers. A systematic review of the literature on respiratory health outcomes was undertaken to describe the available information on new onset of respiratory symptoms and diseases among WTC disaster workers after September 11, 2001. Independent risk factors for respiratory health outcomes included being caught in the dust and debris cloud, early arrival at the WTC site, longer duration of work, and delaying mask and respirator use. Methodological challenges in epidemiologic studies of WTC disaster workers involved study design, exposure misclassification, and limited information on potential confounders and effect modifiers. In the 10 years after 9/11, epidemiologic studies of WTC disaster workers have been essential in investigating the respiratory health consequences of WTC exposure. Longitudinal studies along with continued medical surveillance will be vital in understanding the long-term respiratory burden associated with occupational WTC exposure.

  7. Center for Disaster & Humanitarian Assistance Medicine

    Data.gov (United States)

    Federal Laboratory Consortium — The Center for Disaster and Humanitarian Assistance Medicine (CDHAM) was formally established at the Uniformed Services University of the Health Sciences (USUHS) by...

  8. National Center for Disaster Medicine and Public Health

    Data.gov (United States)

    Federal Laboratory Consortium — The National Center for Disaster Medicine and Public Health (NCDMPH) is an academic center tasked with leading federal, and coordinating national, efforts to develop...

  9. The National Library of Medicine's Disaster Information Management Research Center.

    Science.gov (United States)

    Phillips, Steven J

    2013-12-16

    The Disaster Information Management Research Center (DIMRC) develops and provides access to health information resources and technology for disaster preparedness, response, and recovery. DIMRC focuses on maintaining access to health information at all phases of disasters, developing innovative products and services for emergency personnel, conducting research to support disaster health information management, and collaborating with other agencies and communities. Several tools are available to help emergency responders in hazardous materials or chemical, biological, radiological, or nuclear incidents. Access to the literature is made available through PubMed and the Resource Guide for Disaster Medicine and Public Health, with links to online documents and resources from numerous organizations and government agencies. In addition, DIMRC supports the Disaster Information Specialist Program, a collaborative effort to explore and promote the role of librarians and information specialists in the provision of disaster-related information resources to the workforce and communities.

  10. Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina.

    Science.gov (United States)

    Svendsen, Erik R; Runkle, Jennifer R; Dhara, Venkata Ramana; Lin, Shao; Naboka, Marina; Mousseau, Timothy A; Bennett, Charles

    2012-08-01

    Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.

  11. Disaster preparedness education and a Midwest Regional Poison Center.

    Science.gov (United States)

    Lehman-Huskamp, Kathy; Rebmann, Terri; Walter, Frank G; Weber, Julie; Scalzo, Anthony

    2010-01-01

    To assess knowledge and comfort related to disaster preparedness and response gained and retained from a disaster medicine workshop given to Certified Specialists in Poison Information (CSPI). A pilot study with a pre-post intervention design. A Midwest Regional Poison Center. All CSPIs employed at the participating Poison Center (N = 27) were recruited. Participation ranged from 44 percent (n = 12) for the 4-month postworkshop knowledge quiz to 78 percent (n = 21) for the preworkshop survey. A disaster medicine workshop was given to the CSPIs. Quizzes and surveys were done preworkshop and then repeated at 1 week, 4 months, and 14 months postworkshop. CSPI knowledge and comfort pertaining to disaster-related calls. CSPIs' comfort levels with calls regarding major chemical or nuclear/radiation disasters significantly increased and stayed elevated during all follow-up periods [Kruskal-Wallis chi2 (3) = 13.1, p = 0.01]. The average preworkshop quiz score was 58.2 percent. A statistically significant increase in mean quiz score was demonstrated amongst preworkshop and postworkshop scores at all tested time intervals (F = 18.8, p educational competencies for CSPIs and disaster response would help to standardize this much needed education.

  12. World Trade Center disaster and sensitization to subsequent life stress: A longitudinal study of disaster responders.

    Science.gov (United States)

    Zvolensky, Michael J; Farris, Samantha G; Kotov, Roman; Schechter, Clyde B; Bromet, Evelyn; Gonzalez, Adam; Vujanovic, Anka; Pietrzak, Robert H; Crane, Michael; Kaplan, Julia; Moline, Jacqueline; Southwick, Steven M; Feder, Adriana; Udasin, Iris; Reissman, Dori B; Luft, Benjamin J

    2015-06-01

    The current study examined the role of World Trade Center (WTC) disaster exposure (hours spent working on the site, dust cloud exposure, and losing friend/loved one) in exacerbating the effects of post-disaster life stress on posttraumatic stress disorder (PTSD) symptoms and overall functioning among WTC responders. Participants were 18,896 responders (8466 police officers and 10,430 non-traditional responders) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and were reassessed an average of two years later. Among police responders, there was a significant interaction, such that the effect of post-disaster life stress on later PTSD symptoms and overall functioning was stronger among police responders who had greater WTC disaster exposure (β's=.029 and .054, respectively, for PTSD symptoms and overall functioning). This moderating effect was absent in non-traditional responders. Across both groups, post-disaster life stress also consistently was related to the dependent variables in a more robust manner than WTC exposure. The present findings suggest that WTC exposure may compound post-disaster life stress, thereby resulting in a more chronic course of PTSD symptoms and reduced functioning among police responders. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Simulating and Communicating Outcomes in Disaster Management Situations

    Directory of Open Access Journals (Sweden)

    Michal Lichter

    2015-09-01

    Full Text Available An important, but overlooked component of disaster managment is raising the awareness and preparedness of potential stakeholders. We show how recent advances in agent-based modeling and geo-information analytics can be combined to this effect. Using a dynamic simulation model, we estimate the long run outcomes of two very different urban disasters with severe consequences: an earthquake and a missile attack. These differ in terms of duration, intensity, permanence, and focal points. These hypothetical shocks are simulated for the downtown area of Jerusalem. Outcomes are compared in terms of their potential for disaster mitigation. The spatial and temporal dynamics of the simulation yield rich outputs. Web-based mapping is used to visualize these results and communicate risk to policy makers, planners, and the informed public. The components and design of this application are described. Implications for participatory disaster management and planning are discussed.

  14. The National Library of Medicine’s Disaster Information Management Research Center

    OpenAIRE

    Phillips, Steven J.

    2013-01-01

    The Disaster Information Management Research Center (DIMRC) develops and provides access to health information resources and technology for disaster preparedness, response, and recovery. DIMRC focuses on maintaining access to health information at all phases of disasters, developing innovative products and services for emergency personnel, conducting research to support disaster health information management, and collaborating with other agencies and communities. Several tools are available t...

  15. The World Trade Center Attack Disaster preparedness: health care is ready, but is the bureaucracy?

    Science.gov (United States)

    Mattox, Kenneth

    2001-01-01

    When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. In some geographic locations where natural disasters are common, such as earthquakes in Japan, such disaster practice drills are common. In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness. PMID:11737919

  16. Epidemiologic Methods Lessons Learned from Environmental Public Health Disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina

    Directory of Open Access Journals (Sweden)

    Timothy A. Mousseau

    2012-08-01

    Full Text Available Background: Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Methods: Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA. Findings: We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. Interpretation: These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.

  17. The National Library of Medicine’s Disaster Information Management Research Center

    Directory of Open Access Journals (Sweden)

    Steven Joseph Phillips

    2013-12-01

    Full Text Available The Disaster Information Management Research Center (DIMRC develops and provides access to health information resources and technology for disaster preparedness, response, and recovery. DIMRC focuses on maintaining access to health information at all phases of disasters, developing innovative products and services for emergency personnel, conducting research to support disaster health information management, and collaborating with other agencies and communities. Several tools are available to help emergency responders in hazardous materials or Chemical, Biological, Radiological, or Nuclear incidents. Access to the literature is made available through PubMed and the Resource Guide for Disaster Medicine and Public Health, with links to online documents and resources from numerous organizations and government agencies. In addition, DIMRC supports the Disaster Information Specialist Program, a collaborative effort to explore and promote the role of librarians and information specialists in the provision of disaster-related information resources to the workforce and communities.

  18. Pediatric issues in disaster management, part 2: evacuation centers and family separation/reunification.

    Science.gov (United States)

    Mace, Sharon E; Sharieff, Ghazala; Bern, Andrew; Benjamin, Lee; Burbulys, Dave; Johnson, Ramon; Schreiber, Merritt

    2010-01-01

    Although children and infants are likely to be victims in a disaster and are more vulnerable in a disaster than adults, disaster planning and management has often overlooked the specific needs of pediatric patients. We discuss key components of disaster planning and management for pediatric patients including emergency medical services, hospital/facility issues, evacuation centers, family separation/reunification, children with special healthcare needs, mental health issues, and overcrowding/surge capacity. Specific policy recommendations and an appendix with detailed practical information and algorithms are included. The first part of this three part series on pediatric issues in disaster management addresses the emergency medical system from the field to the hospital and surge capacity including the impact of crowding. The second part addresses the appropriate set up and functioning of evacuation centers and family separation and reunification. The third part deals with special patient populations: the special healthcare needs patient and mental health issues.

  19. Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster.

    Science.gov (United States)

    Zvolensky, Michael J; Kotov, Roman; Schechter, Clyde B; Gonzalez, Adam; Vujanovic, Anka; Pietrzak, Robert H; Crane, Michael; Kaplan, Julia; Moline, Jacqueline; Southwick, Steven M; Feder, Adriana; Udasin, Iris; Reissman, Dori B; Luft, Benjamin J

    2015-02-01

    The current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks. Participants were 18,896 WTC responders, including 8466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; M(age) = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later. Path analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health. The present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress

  20. Birth Outcomes after the Fukushima Daiichi Nuclear Power Plant Disaster: A Long-Term Retrospective Study

    Science.gov (United States)

    Leppold, Claire; Nomura, Shuhei; Sawano, Toyoaki; Ozaki, Akihiko; Tsubokura, Masaharu; Hill, Sarah; Kanazawa, Yukio; Anbe, Hiroshi

    2017-01-01

    Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI): 0.64–1.51; and preterm birth: 0.68, 95% CI: 0.38–1.21). No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health. PMID:28534840

  1. Long-Term Care Resident Outcomes Following a Natural Disaster

    Science.gov (United States)

    Cacchione, Pamela Z.; Willoughby, Lisa M.; Langan, Joanne C.; Culp, Kennith

    2015-01-01

    This report describes the outcomes of 17 long-term care residents who were participating in a nursing intervention study. The residents were evacuated for 5 days due to a severe summer storm that caused widespread power outages. These residents were seen the day of the storm and three times per week for 2 weeks following their return to the nursing home. More than half of the participants had significant changes in their NEECHAM Confusion Scale scores (n = 11) and modified Confusion Assessment Method scores (n = 9) scores, suggesting the onset of delirium. Two participants were hospitalized within the 2 weeks of the evacuation. One participant died unexpectedly. This report provides a rare look into the negative effects of a short-term evacuation due to a natural disaster. PMID:21634311

  2. Non-structural and Functional Vulnerability of Rehabilitation Centers of Tehran Welfare Organization in Disaster

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Hosseini

    2016-04-01

    Conclusion: The functional and non-structural safety of state rehabilitation centers of Tehran welfare organization was above average and vulnerability of centers to disaster was average, too. We suggest that the required planning be performed to improve non-structural and functional safety quality of centers and reduce their vulnerability.

  3. Birth Outcomes after the Fukushima Daiichi Nuclear Power Plant Disaster: A Long-Term Retrospective Study.

    Science.gov (United States)

    Leppold, Claire; Nomura, Shuhei; Sawano, Toyoaki; Ozaki, Akihiko; Tsubokura, Masaharu; Hill, Sarah; Kanazawa, Yukio; Anbe, Hiroshi

    2017-05-19

    Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (<2500 g at birth) and preterm births (<37 weeks gestation at birth) were compared pre- and post-disaster, and regression models were conducted to assess for associations between these outcomes and evacuation and food avoidance. A total of 1101 live singleton births were included. There were no increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI): 0.64-1.51; and preterm birth: 0.68, 95% CI: 0.38-1.21). No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health.

  4. Birth Outcomes after the Fukushima Daiichi Nuclear Power Plant Disaster: A Long-Term Retrospective Study

    Directory of Open Access Journals (Sweden)

    Claire Leppold

    2017-05-01

    Full Text Available Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (<2500 g at birth and preterm births (<37 weeks gestation at birth were compared pre- and post-disaster, and regression models were conducted to assess for associations between these outcomes and evacuation and food avoidance. A total of 1101 live singleton births were included. There were no increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI: 0.64–1.51; and preterm birth: 0.68, 95% CI: 0.38–1.21. No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health.

  5. Disaster recovery using VMware vSphere Replication and vCenter Site Recovery Manager

    CERN Document Server

    GB, Abhilash

    2014-01-01

    This is a step-by-step guide that will help you understand disaster recovery using VMware vSphere Replication 5.5 and VMware vCenter Site Recovery Manager (SRM) 5.5. The topics and configuration procedures are accompanied with relevant screenshots, flowcharts, and logical diagrams that makes grasping the concepts easier. This book is a guide for anyone who is keen on using vSphere Replication or vCenter Site Recovery Manager as a disaster recovery solution. This is an excellent handbook for solution architects, administrators, on-field engineers, and support professionals. Although the book as

  6. Role of the health center in health crisis management, especially in a radiation disaster

    International Nuclear Information System (INIS)

    Kurahashi, Toshiyuki

    2013-01-01

    In a disaster, in particular a radiation disaster, health centers should play an active role in taking advantage of its own expertise. There are various causes of a health crisis; the response to a health crisis is defined according to each cause. However, it should be adequately addressed by assuming the worst case for a health crisis of unknown cause. The role of health centers, in addition to the implementation of appropriate and timely treatment of any health crisis, is prevention of a future health crisis, advanced preparation, and damage recovery; activities during normal times are also important to maintain. Regarding the specific activities of the health center, judgment in the preference of measures to be performed is important. That the information is collected properly based on the idea of risk communication, coordination, and public relations transmission is required also for health centers. (author)

  7. Non-structural & Functional Vulnerability of Rehabilitation Centers of Tehran Welfare Organization in Disaster

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Hosseini

    2016-04-01

    Full Text Available Background: The safety of rehabilitation centers is of great importance to ensure the well-being of patients. The present study aimed to determine non-structural and functional vulnerability of state rehabilitation centers of Tehran City welfare organization in disasters using national standard instruments in 2014. Materials and Methods: This study has a descriptive and cross-sectional design. A total of 17 rehabilitation centers affiliated with Tehran welfare organization are investigated. The vulnerability of centers was measured using 2 checklists of non-structural and functional vulnerability of the World Health Organization. The reliabilities of the non-structural and functional vulnerability instuments were 0.79 and 0.91, respectively, using the Cronbach α. The data were collected through observation and interview with authorities of centers and their staffs. The data analysis was performed through descriptive statistics and 1-sample t-test using SPSS 16. Results: Among 17 rehabilitation centers, the mean functional safety of 11 centers (64.7% was high and showed low vulnerability and safety of 6 centers (35.3% was average and showed average vulnerability. With regard to non-structural safety level, 9 centers (53% of centers had high safety level and showed low vulnerability. Eight centers (47% of centers had average safety level and showed average vulnerability. The results of 1-sample t test showed that at the significance level of 0.05, there was no significant difference between functional and non-structural safety of centers. Conclusion: The functional and non-structural safety of state rehabilitation centers of Tehran welfare organization was above average and vulnerability of centers to disaster was average, too. We suggest that the required planning be performed to improve non-structural and functional safety quality of centers and reduce their vulnerability.

  8. Role of public health center for nuclear disaster

    International Nuclear Information System (INIS)

    Okada, Tsuyoshi

    2012-01-01

    The role of public health center such as surveillance screening, mass decontamination, health consultation and management, and dosage of stable iodine tablets are thought by Nuclear Safety Commission in 2008. The pollution screening and decontamination, internal exposure screening and valuation, dosage of iodine tablets, health consultation of residents and risk communication, comparative evaluation of health risks, health management under the low dose exposure are discussed to handle problems by the government and local government, and to protect the right to know information. In order to prepare the serious health hazard, the children's thyroid gland test and internal exposure test and the follow-up system have to be practiced by the local government. (S.Y.)

  9. Model for determining logistic distribution center: case study of Mount Merapi eruption disaster

    Science.gov (United States)

    Ai, T. J.; Wigati, S. S.

    2017-01-01

    As one of the most active volcano in the earth, Mount Merapi is periodically erupted and it is considered as a natural disaster for the surrounding area. Kabupaten Sleman as one of the nearest location to this mount has to be always prepared to this disaster. The local government already set three different groups of region, in which potentially affected by Mount Merapi eruption, called KRB I, KRB II, and KRB III. Region KRB III is the closest area to the mount crater and most often affected by the eruption disaster. Whenever KRB III is affected, people live in that area usually being transfer to the next region set that is KRB II. The case presented in this paper is located at the KRB II region, which is the second closest region to the mount crater. A humanitarian distribution system has to be set in this region, since usually this region is became the location of shelters for KRB III population whenever a ‘big’ eruption is happened. A mathematical model is proposed in this paper, for determining the location of distribution center, vehicle route, and the amount of goods delivered to each customer. Some numerical illustration are presented in order to know the behavior of the proposed model.

  10. Pilot Implementation of Human-Centered Model in Disaster Management: A Report From Landslides Area in Semarang City

    Directory of Open Access Journals (Sweden)

    Thomas Triadi Putranto

    2017-12-01

    Full Text Available Semarang has a high potential of landslides occurrences in its almost area that should be noted by the stakeholders. Consider this fact, human as the part of the system should be used as a center of the disaster management system to reduce the risk caused by the disaster. An adapted model of human factor toolkits is developed to represent a specific phase of human-centered disaster management. This model presents four phases including major disaster scenario, human error analysis, safety critical task and performance influence factors (PIFs. As the preliminary implementation, this study takes the pilot implementation of each phase of the model to examine the reliability of the concept in the landslide cases, especially in Semarang city. The result shows that there is quite a high deviation between expected and observed behavior of the community and the government institution regarding the awareness states of the system.

  11. Functional, Structural and Non-Structural Preparedness of Ahvaz Health Centers Against Disasters in 2014 – 2015

    Directory of Open Access Journals (Sweden)

    Hatami

    2016-05-01

    Full Text Available Background Ahvaz metropolitan as an industrial pole and special geopolitical location is vulnerable to miscellaneous disasters. Public health centers are one of the most important units that should have necessary preparedness against disasters and crisis. Objectives The current study aimed to determine functional, structural and non-structural preparedness of public health centers against natural and manmade disasters at all levels, rural health houses, rural and urban health centers and the Iranian health centers. Materials and Methods The current descriptive cross-sectional study was carried out on about 47 rural health houses, rural and urban health centers and Iranian health centers of Ahvaz city (western and eastern regions. A checklist of Iran ministry of health, field observation and interview methods were used for data collection. Functional preparedness included crisis management framework, planning, insurance coverage, event management system, public services, education and manure. Non-structural preparedness was assessed in three levels as desirable, mid desirable and undesirable. Structural preparedness included instruments, structures and facilities of the health centers. All calculations were performed by excel software. Results Risk rate, functional, non-structural and structural preparedness and final safety level were 58.62%, 51.48%, 54.82%, 33.97%, and 43.72%, respectively. Conclusions According to the results, the Iranian public health centers preparedness against disasters before, during and after accidents were in safety level 4 from 10, which was undesirable.

  12. Multi-sensor fusion over the World Trade Center disaster site

    Science.gov (United States)

    Rodarmel, Craig; Scott, Lawrence; Simerlink, Deborah A.; Walker, Jeffrey

    2002-09-01

    The immense size and scope of the rescue and clean-up of the World Trade Center site created a need for data that would provide a total overview of the disaster area. To fulfill this need, the New York State Office for Technology (NYSOFT) contracted with EarthData International to collect airborne remote sensing data over Ground Zero with an airborne light detection and ranging (LIDAR) sensor, a high-resolution digital camera, and a thermal camera. The LIDAR data provided a three-dimensional elevation model of the ground surface that was used for volumetric calculations and also in the orthorectification of the digital images. The digital camera provided high-resolution imagery over the site to aide the rescuers in placement of equipment and other assets. In addition, the digital imagery was used to georeference the thermal imagery and also provided the visual background for the thermal data. The thermal camera aided in the location and tracking of underground fires. The combination of data from these three sensors provided the emergency crews with a timely, accurate overview containing a wealth of information of the rapidly changing disaster site. Because of the dynamic nature of the site, the data was acquired on a daily basis, processed, and turned over to NYSOFT within twelve hours of the collection. During processing, the three datasets were combined and georeferenced to allow them to be inserted into the client's geographic information systems.

  13. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools.

    Science.gov (United States)

    Ingrassia, Pier Luigi; Ragazzoni, Luca; Tengattini, Marco; Carenzo, Luca; Della Corte, Francesco

    2014-10-01

    In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of "Disaster Health" according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants' knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners

  14. Serious gaming for user centered innovation and adoption of disaster response information systems

    NARCIS (Netherlands)

    Meesters, Kenny; Van De Walle, Bartel A

    2014-01-01

    Global profusion of information technology has spawned a large and varied number of tools and systems to aid disaster responders in managing disaster-related information. To adequately study the conception, development and deployment of such tools and systems, the user and the operational context in

  15. Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS): Psychometric Testing of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool

    Science.gov (United States)

    Hansel, Tonya Cross; Osofsky, Joy D.; Osofsky, Howard J.

    2015-01-01

    Background: Post disaster psychosocial surveillance procedures are important for guiding effective and efficient recovery. The Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS) is a model designed with the goal of assisting recovering communities in understanding the needs of and targeting services…

  16. Transplant tourism outcome: a single center experience.

    Science.gov (United States)

    Alghamdi, Saad A; Nabi, Zahid G; Alkhafaji, Dania M; Askandrani, Sumaya A; Abdelsalam, Mohamed S; Shukri, Mohamed M; Eldali, Abdelmoneim M; Adra, Chaker N; Alkurbi, Lutfi A; Albaqumi, Mamdouh N

    2010-07-27

    Transplant tourism is the term used for patients who travel abroad for transplantation. Transplant tourism has always been surrounded with controversy regarding how these organs were obtained, the donor's care after transplantation, and the recipient outcome. Many authors have found that the outcome of the recipients in transplant tourism is inferior to those transplanted in their own countries. However, most these studies were small, with the latest one including only 33 patients. Here, we describe the outcome of 93 patients who were transplanted abroad compared with local transplantation. All transplant patients who were followed up at our Nephrology Clinic from 1998 until 2008 were identified using our data base system. We selected patients transplanted from 2003 and forward because the computerized system for laboratory and electronic records began operation that year. A total of 165 patients were identified (93 in the tourist group and 72 in the local one). Transplant tourists had a higher rate of acute rejection in the first year compared with local transplantation (27.9% vs. 9.9, P=0.005), higher mean creatinine at 6 months and 1 year (120 vs. 101 micromol/L, P=0.0007, 113 vs. 98 micromol/L, P=0.008). There was no statistical difference in graft or patient survival in 1 or 2 years after transplantation. However, transplant tourist had a higher rate of cytomegalovirus infection (15.1% vs. 5.6%, P=0.05) and hepatitis C seroconversion (7.5% vs. 0%, P=0.02). Transplant tourists had a more complex posttransplantation course with higher incidence of acute rejection and infectious complications.

  17. Planning and Implementing a Disaster Recovery Capability for a Mainframe-Based Hospital Information System: Duke University Medical Center's Experience

    Science.gov (United States)

    Kirby, J. David; Walker, L. Phillip; Aaron, Walter H.; Whitesell, Judy J.; Stead, William W.

    1988-01-01

    Since October 1986, the Medical Center Information Systems Department at Duke University Medical Center (DUMC) has been developing and implementing a plan to provide for the continuation of the functions performed by Duke Hospital's central computing system in the event of a disaster that would disable the central hardware configuration for an extended amount of time. The key characteristic of the plan is that it provides for the full function and performance of the system to be returned to the end users within twenty four hours of the primary system's failure.

  18. Depressive symptoms following natural disaster in Korea: psychometric properties of the Center for Epidemiologic Studies Depression Scale.

    Science.gov (United States)

    Cho, Sungkun; Cho, Yongrae

    2017-11-28

    Depressive symptoms have been recognized as one of the most frequent complaints among natural disaster survivors. One of the most frequently used self-report measures of depressive symptoms is the Center for Epidemiologic Studies Depression Scale (CES-D). To our knowledge, no study has yet examined the factor structure, reliability, and validity of the CES-D in a sample of natural disaster survivors. Thus, the present study investigated the factor structure, reliability, and validity of a Korean language version of the CES-D (KCES-D) for natural disaster survivors. We utilized two archived datasets collected independently for two different periods in 2008 in the same region of Korea (n = 192 for sample 1; n = 148 for sample 2). Participants were survivors of torrential rains in the mid-eastern region of the Korean peninsula. For analysis, Samples 1 and 2 were merged (N = 340). Confirmatory factor analysis was performed to evaluate the one-factor model, the four-factor model, and the bi-factor models, as well as the second-order factor model. Composite reliability was computed to examine the internal consistency of the KCES-D total and subscale scores. Finally, Pearson's r was computed to examine the relationship between the KCES-D and the trauma-related measures. The four-factor model provided the best fit to the data among the alternatives. The KCES-D showed adequate internal consistency, except for the 'interpersonal difficulties' subscale. Also regarding concurrent validity, weak to moderate positive correlations were observed between the KCES-D and the trauma-related measures. The results support the four-factor model and indicate that the KCES-D has adequate psychometric properties for natural disaster survivors. If these findings are further confirmed, the KCES-D can be used as a useful, rapid, and inexpensive screening tool for assessing depressive symptoms in natural disaster survivors.

  19. Compliance of child care centers in Pennsylvania with national health and safety performance standards for emergency and disaster preparedness.

    Science.gov (United States)

    Olympia, Robert P; Brady, Jodi; Kapoor, Shawn; Mahmood, Qasim; Way, Emily; Avner, Jeffrey R

    2010-04-01

    To determine the preparedness of child care centers in Pennsylvania to respond to emergencies and disasters based on compliance with National Health and Safety Performance Standards for Out-of-Home Child Care Programs. A questionnaire focusing on the presence of a written evacuation plan, the presence of a written plan for urgent medical care, the immediate availability of equipment and supplies, and the training of staff in first aid/cardiopulmonary resuscitation (CPR) as delineated in Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs, 2nd Edition, was mailed to 1000 randomly selected child care center administrators located in Pennsylvania. Of the 1000 questionnaires sent, 496 questionnaires were available for analysis (54% usable response rate). Approximately 99% (95% confidence interval [CI], 99%-100%) of child care centers surveyed were compliant with recommendations to have a comprehensive written emergency plan (WEP) for urgent medical care and evacuation, and 85% (95% CI, 82%-88%) practice their WEP periodically throughout the year. More than 20% of centers did not have specific written procedures for floods, earthquakes, hurricanes, blizzards, or bomb threats, and approximately half of the centers did not have specific written procedures for urgent medical emergencies such as severe bleeding, unresponsiveness, poisoning, shock/heart or circulation failure, seizures, head injuries, anaphylaxis or allergic reactions, or severe dehydration. A minority of centers reported having medications available to treat an acute asthma attack or anaphylaxis. Also, 77% (95% CI, 73%-80%) of child care centers require first aid training for each one of its staff members, and 33% (95% CI, 29%-37%) require CPR training. Although many of the child care centers we surveyed are in compliance with the recommendations for emergency and disaster preparedness, specific areas for improvement include increasing the frequency

  20. PTSD onset and course following the World Trade Center disaster: findings and implications for future research.

    Science.gov (United States)

    Boscarino, Joseph A; Adams, Richard E

    2009-10-01

    We sought to identify common risk factors associated with posttraumatic stress disorder (PTSD) onset and course, including delayed, persistent, and remitted PTSD following a major traumatic exposure. Based on a prospective study of New York City adults following the World Trade Center disaster (WTCD), we conducted baseline interviews with 2,368 persons one year after this event and then at follow-up 1 year later to evaluate changes in current PTSD status based on DSM-IV criteria. Baseline analysis suggested that current PTSD, defined as present if this occurred in the past 12 months, was associated with females, younger adults, those with lower self-esteem, lower social support, higher WTCD exposure, more lifetime traumatic events, and those with a history of pre-WTCD depression. At follow-up, current PTSD was associated with Latinos, non-native born persons, those with lower self-esteem, more negative life events, more lifetime traumatic events, and those with mixed handedness. Classifying respondents at follow-up into resilient (no PTSD time 1 or 2), remitted (PTSD time 1, not 2), delayed (no PTSD time 1, but PTSD time 2), and persistent (PTSD both time 1 and 2) PTSD, revealed the following: compared to resilient cases, remitted ones were more likely to be female, have more negative life events, have greater lifetime traumatic events, and have pre-WTCD depression. Delayed cases were more likely to be Latino, be non-native born, have lower self-esteem, have more negative life events, have greater lifetime traumas, and have mixed handedness. Persistent cases had a similar profile as delayed, but were the only cases associated with greater WTCD exposures. They were also likely to have had a pre-WTCD depression diagnosis. Examination of WTCD-related PTSD at follow-up, more specifically, revealed a similar risk profile, except that handedness was no longer significant and WTCD exposure was now significant for both remitted and persistent cases. PTSD onset and course

  1. Mold After a Disaster

    Science.gov (United States)

    ... About CDC.gov . Natural Disasters and Severe Weather Earthquakes Being Prepared Emergency Supplies Home Hazards Indoor Safety ... Are You Prepared? Information for Specific Groups Disaster Evacuation Centers Infection Control Infection Control Guidance for Community ...

  2. Reproductive Outcomes Following Maternal Exposure to the Events of September 11, 2001, at the World Trade Center, in New York City.

    Science.gov (United States)

    Maslow, Carey B; Caramanica, Kimberly; Li, Jiehui; Stellman, Steven D; Brackbill, Robert M

    2016-10-01

    To estimate associations between exposure to the events of September 11, 2001, (9/11) and low birth weight (LBW), preterm delivery (PD), and small size for gestational age (SGA). We matched birth certificates filed in New York City for singleton births between 9/11 and the end of 2010 to 9/11-related exposure data provided by mothers who were World Trade Center Health Registry enrollees. Generalized estimating equations estimated associations between exposures and LBW, PD, and SGA. Among 3360 births, 5.8% were LBW, 6.5% were PD, and 9% were SGA. Having incurred at least 2 of 4 exposures, having performed rescue or recovery work, and probable 9/11-related posttraumatic stress disorder 2 to 3 years after 9/11 were associated with PD and LBW during the early study period. Disasters on the magnitude of 9/11 may exert effects on reproductive outcomes for several years. Women who are pregnant during and after a disaster should be closely monitored for physical and psychological sequelae. In utero and maternal disaster exposure may affect birth outcomes. Researchers studying effects of individual disasters should identify commonalities that may inform postdisaster responses to minimize disaster-related adverse birth outcomes.

  3. The influence of global warming on natural disasters and their public health outcomes.

    Science.gov (United States)

    Diaz, James H

    2007-01-01

    With a documented increase in average global surface temperatures of 0.6 degrees C since 1975, Earth now appears to be warming due to a variety of climatic effects, most notably the cascading effects of greenhouse gas emissions resulting from human activities. There remains, however, no universal agreement on how rapidly, regionally, or asymmetrically the planet will warm or on the true impact of global warming on natural disasters and public health outcomes. Most reports to date of the public health impact of global warming have been anecdotal and retrospective in design and have focused on the increase in heat-stroke deaths following heat waves and on outbreaks of airborne and arthropod-borne diseases following tropical rains and flooding that resulted from fluctuations in ocean temperatures. The effects of global warming on rainfall and drought, tropical cyclone and tsunami activity, and tectonic and volcanic activity will have far-reaching public health effects not only on environmentally associated disease outbreaks but also on global food supplies and population movements. As a result of these and other recognized associations between climate change and public health consequences, many of which have been confounded by deficiencies in public health infrastructure and scientific debates over whether climate changes are spawned by atmospheric cycles or anthropogenic influences, the active responses to progressive climate change must include combinations of economic, environmental, legal, regulatory, and, most importantly, public health measures.

  4. Impact of local circumstances on outcome of renal casualties in major disasters.

    Science.gov (United States)

    van der Tol, Arjan; Hussain, Asrar; Sever, Memhet Sukru; Claus, Stefaan; Van Biesen, Wim; Hoste, Eric; Khan, Samuel; Vanholder, Raymond

    2009-03-01

    In the aftermath of earthquakes, the cumulative incidence of crush-induced acute kidney injury (AKI) is difficult to predict. Insight into factors determining this risk is indispensable to allow adequate logistical planning, which is a prerogative for success in disaster management. Data of 88 crush-related AKI patients in the aftermath of the Kashmir earthquake were collected and outcome measures were analysed. Then the findings were compared with the data of 596 crush-related AKI patients of the Marmara earthquake. The earthquake in Kashmir occurred in a rural area with lack of medical facilities and difficult transportation conditions while the earthquake in Marmara occurred in an urban area with more efficient transport possibilities. In Kashmir we reported fewer patients with treated AKI (1.2 AKI per 1000 deaths, 1.3 AKI per 1000 victims) than in Marmara (34.1 AKI per 1000 deaths; P earthquake and admission to hospitals was longer in Kashmir (5.8 +/- 5.8 days) than in Marmara (3.5 +/- 3.7 days; P frequencies of fasciotomies (P earthquakes. Many factors may affect the frequency of AKI: hampered rescue and transport possibilities; destroyed medical facilities on the spot; availability or not of sophisticated therapeutic possibilities and structure of the buildings might all have impacted on different cumulative incidence between Kashmir and Marmara.

  5. Applications of NASA and NOAA Satellite Observations by NASA's Short-term Prediction Research and Transition (SPoRT) Center in Response to Natural Disasters

    Science.gov (United States)

    Molthan, Andrew L.; Burks, Jason E.; McGrath, Kevin M.; Jedlovec, Gary J.

    2012-01-01

    NASA s Short-term Prediction Research and Transition (SPoRT) Center supports the transition of unique NASA and NOAA research activities to the operational weather forecasting community. SPoRT emphasizes real-time analysis and prediction out to 48 hours. SPoRT partners with NOAA s National Weather Service (NWS) Weather Forecast Offices (WFOs) and National Centers to improve current products, demonstrate future satellite capabilities and explore new data assimilation techniques. Recently, the SPoRT Center has been involved in several activities related to disaster response, in collaboration with NOAA s National Weather Service, NASA s Applied Sciences Disasters Program, and other partners.

  6. Availability of a pediatric trauma center in a disaster surge decreases triage time of the pediatric surge population: a population kinetics model

    Directory of Open Access Journals (Sweden)

    Grikscheit Tracy C

    2011-10-01

    Full Text Available Abstract Background The concept of disaster surge has arisen in recent years to describe the phenomenon of severely increased demands on healthcare systems resulting from catastrophic mass casualty events (MCEs such as natural disasters and terrorist attacks. The major challenge in dealing with a disaster surge is the efficient triage and utilization of the healthcare resources appropriate to the magnitude and character of the affected population in terms of its demographics and the types of injuries that have been sustained. Results In this paper a deterministic population kinetics model is used to predict the effect of the availability of a pediatric trauma center (PTC upon the response to an arbitrary disaster surge as a function of the rates of pediatric patients' admission to adult and pediatric centers and the corresponding discharge rates of these centers. We find that adding a hypothetical pediatric trauma center to the response documented in an historical example (the Israeli Defense Forces field hospital that responded to the Haiti earthquake of 2010 would have allowed for a significant increase in the overall rate of admission of the pediatric surge cohort. This would have reduced the time to treatment in this example by approximately half. The time needed to completely treat all children affected by the disaster would have decreased by slightly more than a third, with the caveat that the PTC would have to have been approximately as fast as the adult center in discharging its patients. Lastly, if disaster death rates from other events reported in the literature are included in the model, availability of a PTC would result in a relative mortality risk reduction of 37%. Conclusions Our model provides a mathematical justification for aggressive inclusion of PTCs in planning for disasters by public health agencies.

  7. Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

    Science.gov (United States)

    Osofsky, Howard J; Weems, Carl F; Hansel, Tonya Cross; Speier, Anthony H; Osofsky, Joy D; Graham, Rebecca; King, Lucy; Craft, Timothy K

    2017-06-01

    Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001.

    Science.gov (United States)

    Thomas, Pauline A; Brackbill, Robert; Thalji, Lisa; DiGrande, Laura; Campolucci, Sharon; Thorpe, Lorna; Henning, Kelly

    2008-10-01

    Effects of the World Trade Center (WTC) disaster on children's respiratory health have not been definitively established. This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health. Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003-2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates. Among 3,184 children enrolled, 28% were < 5 years of age on 9/11; 34%, 5-11 years; and 39%, 12-17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3; 95% confidence interval, 1.5-3.5). Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.

  9. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  10. Evaluation of the association between disaster training and confidence in disaster response among graduate medical trainees: A cross-sectional study.

    Science.gov (United States)

    Grock, Andrew; Aluisio, Adam R; Abram, Elizabeth; Roblin, Patricia; Arquilla, Bonnie

    2017-01-01

    Disasters by definition overwhelm the resources of a hospital and may require a response from a range of practitioners. Disaster training is part of emergency medicine (EM) resident curricula, but less emphasized in other training programs. This study aimed to compare disaster educational training and confidence levels among resident trainees from multiple specialties. A structured questionnaire assessed graduate medical training in disaster education and self-perceived confidence in disaster situations. Cross-sectional sampling of resident trainees from the departments of surgery, pediatrics, internal medicine, and EM was performed. The study took place at a large urban academic medical center during March 2013. Among 331 available residents, a convenience sample of 157 (47.4 percent) was obtained. Outcomes investigated include resident confidence in various disaster scenarios, volume of disaster training currently received, and preferred education modality. EM trainees reported 7.3 hours of disaster instruction compared to 1.3 hours in non-EM trainees (p training.

  11. Changing clinical characteristics of thyroid carcinoma at a single center from Turkey: before and after the Chernobyl disaster.

    Science.gov (United States)

    Ozdemir, D; Dagdelen, S; Kiratli, P; Tuncel, M; Erbas, B; Erbas, T

    2012-09-01

    The aim of the study was to determine the possible role of Chernobyl disaster on changing clinical features of thyroid carcinoma (TC) in a moderately iodine deficient region. We retrospectively reviewed demographical features, presenting symptoms, tumor size, histopathological diagnosis and distant metastates in 160 patients with TC diagnosed between 1990-2007. We compared our findings with the database of 118 TC patients diagnosed between 1970-1990 in the same center. There were 123 female (76.9%) and 37 (23.1%) male patients with a mean age of 44.89±14.84. Sex distribution and age at diagnosis were similar between 1970-1990 and 1990-2007 (P=0.77 and P=0.42, respectively). Histopathological diagnoses were papillary in 114 (73.1%), follicular in 22 (14.1%), medullary in 9 (5.8%), hurthle cell in 7 (4.5%) and anaplastic TC in 4 (2.6%) patients. We observed a marked increase in papillary TC (PChernobyl fallout in a moderately iodine deficient area. Presenting symptoms of TC have changed and microcarcinomas are diagnosed more frequently compared to past. Further large scale trials are needed to find out whether Chernobyl disaster has role on changing characteristic of TC in countries that are not very near but also not very far from Chernobyl such as Turkey.

  12. Building a Student-Centered Culture in Times of Natural Disaster: A Case Study

    Science.gov (United States)

    Hlinka, Karen Ramey

    2013-01-01

    Increased rates of student success and persistence have been positively linked to community colleges with student-centered cultures. A student-centered culture is one in which policies and practices promote a consistent message of concern and respect while expecting high standards of academic accomplishment. Developing a student-centered culture…

  13. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings.

    Science.gov (United States)

    Brackbill, Robert M; Thorpe, Lorna E; DiGrande, Laura; Perrin, Megan; Sapp, James H; Wu, David; Campolucci, Sharon; Walker, Deborah J; Cone, Jim; Pulliam, Paul; Thalji, Lisa; Farfel, Mark R; Thomas, Pauline

    2006-04-07

    Survivors of collapsed or damaged buildings from the attack on the World Trade Center (WTC) were among those most exposed to injury hazards, air pollution, and traumatic events. This report summarizes data from health outcomes collected during interviews conducted from September 5, 2003, to the close of the World Trade Center Health Registry (WTCHR) enrollment on November 20, 2004. WTCHR will be used to monitor periodically the mental and physical health of 71,437 enrollees for 20 years. The analysis is limited to 8,418 adult survivors of collapsed buildings (n = 5,095) and buildings with major or moderate damage (n = 3,323), excluding those who were involved in rescue and recovery. A total of 62.4% of survivors of collapsed or damaged buildings were caught in the dust and debris cloud that resulted from the collapse of the WTC towers, and 63.8% experienced three or more potentially psychologically traumatizing events. Injuries were common (43.6%), but few survivors reported injuries that would have required extensive treatment. More than half (56.6%) of survivors reported experiencing new or worsening respiratory symptoms after the attacks, 23.9% had heartburn/reflux, and 21.0% had severe headaches. At the time of the interview, 10.7% of building survivors screened positive for serious psychological distress (SPD) using the K6 instrument. After multiple adjustments, data indicated that survivors caught in the dust and debris cloud were more likely to report any injuries (adjusted odds ratio [AOR] = 3.9; p< or =0.05); any respiratory symptom (AOR = 2.7; p< or =0.05); severe headaches (AOR = 2.0; p< or =0.05); skin rash/irritation (AOR = 1.7; p< or =0.05); hearing problems or loss (AOR = 1.7; p< or =0.05); heartburn (AOR = 1.7; p< or =0.05); diagnosed stroke (AOR = 5.6; p< or =0.05); self-reported depression, anxiety, or other emotional problem (AOR = 1.4; p< or =0.05); and current SPD (AOR = 2.2; p< or =0.05). Adjustment for SPD did not diminish the observed

  14. The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th.

    Science.gov (United States)

    Cukor, Judith; Wyka, Katarzyna; Mello, Brittany; Olden, Megan; Jayasinghe, Nimali; Roberts, Jennifer; Giosan, Cezar; Crane, Michael; Difede, Joann

    2011-10-01

    This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed. Copyright © 2011 International Society for Traumatic Stress Studies.

  15. Facebook, quality of life, and mental health outcomes in post-disaster urban environments: the l'aquila earthquake experience.

    Science.gov (United States)

    Masedu, Francesco; Mazza, Monica; Di Giovanni, Chiara; Calvarese, Anna; Tiberti, Sergio; Sconci, Vittorio; Valenti, Marco

    2014-01-01

    An understudied area of interest in post-disaster public health is individuals' use of social networks as a potential determinant of quality of life (QOL) and mental health outcomes. A population-based cross-sectional study was carried out to examine whether continual use of online social networking (Facebook) in an adult population following a massive earthquake was correlated with prevalence of depression and post-traumatic stress disorders (PTSD) and QOL outcomes. Participants were a sample of 890 adults aged 25-54 who had been exposed to the L'Aquila earthquake of 2009. Definition of "user" required a daily connection to the Facebook online social network for more than 1 h per day from at least 2 years. Depression and PTSD were assessed using the Screening Questionnaire for Disaster Mental Health. QOL outcomes were measured using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) instrument. Logistic regression was carried out to calculate the prevalence odds ratios (POR) for social network use and other covariates. Two hundred and twenty one of 423 (52.2%) men, and 195 of 383 (50.9%) women, had been using Facebook as social network for at least 2 years prior to our assessment. Social network use correlated with both depression and PTSD, after adjusting for gender. A halved risk of depression was found in users vs. non-users (POR 0.50 ± 0.16). Similarly, a halved risk of PTSD in users vs. non-users (POR 0.47 ± 0.14) was found. Both men and women using online social networks had significantly higher QOL scores in the psychological and social domains of the WHOQOL-BREF. Social network use among adults 25-54 years old has a positive impact on mental health and QOL outcomes in the years following a disaster. The use of social networks may be an important tool for coping with the mental health outcomes of disruptive natural disasters, helping to maintain, if not improve, QOL in terms of social relationships and psychological distress.

  16. Facebook, quality of life and mental health outcomes in post-disaster urban environments: the L’Aquila earthquake experience

    Directory of Open Access Journals (Sweden)

    Francesco eMasedu

    2014-12-01

    Full Text Available BackgroundAn understudied area of interest in post-disaster public health is individuals’ use of social networks as a potential determinant of quality of life (QOL and mental health outcomes. A population-based cross-sectional study was carried out to examine whether continual use of online social networking (Facebook in an adult population following a massive earthquake was correlated with prevalence of depression and PTSD and QOL outcomes. MethodsParticipants were a sample of 890 adults aged 25 to 54 who had been exposed to the L'Aquila earthquake of 2009. Definition of user required a daily connection to the Facebook online social network for more than one hour per day from at least two years.Depression and PTSD were assessed using the Screening Questionnaire for Disaster Mental Health (SQD. QOL outcomes were measured using the WHOQOL-BREF instrument. Logistic regression was carried out to calculate the prevalence odds ratios (POR for social network use and other covariates.ResultsTwo hundred and twenty one of 423 (52.2% men, and 195 of 383 (50.9% women, had been using Facebook as social network for at least two years prior to our assessment. Social network use correlated with both depression and PTSD, after adjusting for gender. A halved risk of depression was found in users vs. non-users (POR 0.50±0.16. Similarly, a halved risk of PTSD in users vs. non-users (POR 0.47±0.14 was found. Both men and women using online social networks had significantly higher QOL scores in the psychological and social domains of the WHOQOL-BREF.ConclusionsSocial network use among adults 25 to 54 years old has a positive impact on mental health and QOL outcomes in the years following a disaster. The use of social networks may be an important tool for coping with the mental health outcomes of disruptive natural disasters, helping to maintain, if not improve, QOL in terms of social relationships and psychological distress.

  17. Serum perfluoroalkyl substances and cardiometabolic consequences in adolescents exposed to the World Trade Center disaster and a matched comparison group.

    Science.gov (United States)

    Koshy, Tony T; Attina, Teresa M; Ghassabian, Akhgar; Gilbert, Joseph; Burdine, Lauren K; Marmor, Michael; Honda, Masato; Chu, Dinh Binh; Han, Xiaoxia; Shao, Yongzhao; Kannan, Kurunthachalam; Urbina, Elaine M; Trasande, Leonardo

    2017-12-01

    Large amounts of various chemical contaminants, including perfluoroalkyl substances (PFASs), were released at the time of the World Trade Center (WTC) disaster. Thousands of children who lived and/or attended school near the disaster site were exposed to these substances but few studies have examined the possible consequences related to these exposures. To examine the relationship of PFASs serum levels with cardiometabolic profile in children and adolescents enrolled in the World Trade Center Health Registry (WTCHR) and a matched comparison group. We evaluated WTCHR enrollees who resided in New York City and were born between September 11, 1993 and September 10, 2001, and a matched comparison group consisting of individuals who were ineligible for WTCHR participation upon distance of their home, school or work from the WTC and lack of participation in rescue and recovery activities. Matching was based on date of birth, sex, race, ethnicity, and income. We assessed exposure to PFASs, as measured by serum levels and association with cardiometabolic profile as measured by arterial wall stiffness, body mass index, insulin resistance, fasting total cholesterol, HDL, LDL and triglycerides. A total of 402 participants completed the study and serum samples were analyzed from 308 participants, 123 in the WTCHR group and 185 in the comparison group. In multivariable regression analysis, after adjusting for relevant confounders, we observed a significant, positive association of perfluorooctanoic acid (PFOA) with triglycerides (beta coefficient=0.14, 95% CI: 0.02, 0.27, 15.1% change), total cholesterol (beta coefficient=0.09, 95% CI: 0.04, 0.14, 9.2% change), and LDL cholesterol (beta coefficient=0.11, 95% CI: 0.03, 0.19, 11.5% change). Perfluorohexanesulfonic acid levels were associated with decreased insulin resistance (beta coefficient=-0.09, 95% CI: -0.18, -0.003, -8.6% change); PFOA and perfluorononanoic acid were associated with increased brachial artery distensibility

  18. Pediatric disaster preparedness in the medical setting: integrating mental health.

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    Gold, Jeffrey I; Montano, Zorash; Shields, Sandra; Mahrer, Nicole E; Vibhakar, Viktoria; Ybarra, Tanya; Yee, Nancy; Upperman, Jeffrey; Blake, Nancy; Stevenson, Kathleen; Nager, Alan L

    2009-01-01

    The increasing prevalence of disasters worldwide highlights the need for established and universal disaster preparedness plans. The devastating events of September 11 and Hurricane Katrina have spurred the development of some disaster response systems. These systems, however, are predominantly focused on medical needs and largely overlook mental health considerations. Negative outcomes of disasters include physical damage as well as psychological harm. Mental health needs should be considered throughout the entire disaster response process, especially when caring for children, adolescents, and their families. To provide an overview and recommendations for the integration of mental health considerations into pediatric disaster preparedness and response in the medical setting. Recommendations were developed by a panel of disaster preparedness and mental health experts during the Childrens Hospital Los Angeles Pediatric Disaster Resource and Training Center: Workshop on Family Reunification in Los Angeles, California, March 31-April 1, 2008. Experts discussed the inclusion of mental health-specific considerations and services at all stages of disaster preparedness and response. Recommendations involve the integration of mental health into triage and tracking, the adoption of a child ambassador model, environment, and developmentally appropriate interventions, education, communication, death notification, and family reunification. The inclusion of mental health concerns into pediatric disaster preparedness may help prevent further and unnecessary psychological harm to children and adolescent survivors following a disaster.

  19. Variation in Outcomes at Bariatric Surgery Centers of Excellence.

    Science.gov (United States)

    Ibrahim, Andrew M; Ghaferi, Amir A; Thumma, Jyothi R; Dimick, Justin B

    2017-07-01

    In the United States, reports about perioperative complications associated with bariatric surgery led to the establishment of accreditation criteria for bariatric centers of excellence and many bariatric centers obtaining accreditation. Currently, most bariatric procedures occur at these centers, but to what extent they uniformly provide high-quality care remains unknown. To describe the variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers. This retrospective review analyzed the claims data of 145 527 patients who underwent bariatric surgery at bariatric centers of excellence between January 1, 2010, and December 31, 2013. Data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. This database included unique hospital identification numbers in 12 states (Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin), allowing comparisons among 165 centers of excellence located in those states. Participants were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Those included in the study cohort were patients with a primary diagnosis of morbid obesity and who underwent laparoscopic Roux-en-Y gastric bypass, open Roux-en-Y gastric bypass, laparoscopic gastric band placement, or laparoscopic sleeve gastrectomy. Excluded from the cohort were patients younger than 18 years or who had an abdominal malignant neoplasm. Data were analyzed July 1, 2016, through January 10, 2017. Risk-adjusted and reliability-adjusted serious complication rates within 30 days of the index operation were calculated for each center. Centers were stratified by geographic location and operative volume. In this analysis of claims data from 145 527 patients, wide variation in quality was found across 165 bariatric centers of excellence, both nationwide and

  20. The post-disaster negative health legacy: pregnancy outcomes in Louisiana after Hurricane Andrew.

    Science.gov (United States)

    Antipova, Anzhelika; Curtis, Andrew

    2015-10-01

    Disasters and displacement increasingly affect and challenge urban settings. How do pregnant women fare in the aftermath of a major disaster? This paper investigates the effect of pregnancies in disaster situations. The study tests a hypothesis that pregnant women residing in hurricane-prone areas suffer higher health risks. The setting is Louisiana in the Gulf Coast, United States, a state that continually experiences hurricane impacts. The time period for the analysis is three years following the landfall of Hurricane Andrew in 1992. We analysed low birth weight and preterm deliveries before and after landfall, as a whole and by race. Findings support an association between hazards and health of a community and indicate that pregnant women in the affected area, irrespective of race, are more likely to experience preterm deliveries compared to pre-event births. Results suggest there is a negative health legacy impact in Louisiana as a result of hurricane landfall. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

  1. Outcome of major cardiac injuries at a Canadian trauma center

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    Lamy Andre

    2002-06-01

    Full Text Available Abstract Background Canadian trauma units have relatively little experience with major cardiac trauma (disruption of a cardiac chamber so injury outcome may not be comparable to that reported from other countries. We compared our outcomes to those of other centers. Methods Records of patients suffering major cardiac trauma over a nine-year period were reviewed. Factors predictive of outcome were analyzed. Results Twenty-seven patients (11 blunt and 16 penetrating with major cardiac trauma were evaluated. Injury severity scores (ISS were similar for blunt (49.6 ± 16.6 and penetrating (39.5 ± 21.6, p = 0.20 injuries. Five of 11 blunt trauma patients, and 9 of 16 penetrating trauma patients, had detectable vital signs on hospital arrival (p = 0.43. Ten patients underwent emergency department thoracotomy and 11 patients had cardiac repair in the operating theatre. Eleven patients survived and 16 died. Survivors had a lower ISS (33.7 ± 15.4 than non-survivors (50.4 ± 20.4; p = 0.03. Two of 11 blunt trauma patients and 9 of 16 penetrating trauma patients survived (p = 0.06. Eleven of 14 patients with detectable vital signs survived; all 13 without detectable vital signs died (p = 0.00003. Ten of eleven patients treated in the operating theatre survived, while only one of the other 16 patients survived (p = 0.00002. Conclusions Patients with major cardiac injuries and detectable vital signs on hospital arrival can be salvaged by prompt surgical intervention in the operating theatre. Major cardiac injuries are infrequently encountered at our center but patient survival is comparable to that reported from trauma units in other countries.

  2. Radiation disaster response: preparation and simulation experience at an academic medical center.

    Science.gov (United States)

    Schleipman, A Robert; Gerbaudo, Victor H; Castronovo, Frank P

    2004-03-01

    A mass casualty disaster drill involving the simulated explosion of a radiation dispersal device (dirty bomb) was performed with the participation of multiple hospitals, emergency responders, and governmental agencies. The exercise was designed to stress trauma service capacities, communications, safety, and logistic functions. We report our experience and critique of the planning, training, and execution of the exercise, with special attention to the integrated response of the Departments of Nuclear Medicine, Health Physics, and Emergency Medicine. The Health Physics Department presented multiple training sessions to the Emergency Medicine Department, Operating Room, and ancillary staff; reviewing basics of radiation biology and risk, protection standards, and detection of radiocontamination. Competency-based simulations using Geiger-Müller detectors and sealed sources were performed. Two nuclear medicine technologists played an important role in radiation discrimination-that is, assessment of radioactive contamination with survey meters and radionuclide identification based on gamma-spectroscopy of wipe smears from patients' clothing, skin, and orifices. Three Health Physics personnel and one senior Nuclear Medicine staff member were designated the radiation control officers for assigned teams triaging or treating patients. Patients were triaged and, when indicated, decontaminated. Within a 2-h period, 21 simulated victims arrived at our institution's Emergency Room. Of these, 11 were randomized as noncontaminated, with 10 as contaminated. Decontamination procedures were implemented in a hazardous materials (HAZMAT) decontamination trailer and, for the 5 patients with simulated serious injuries, in a designated trauma room. A full debriefing took place at the conclusion of the exercise. Staff largely complied with appropriate radiation protection protocols, although decontamination areas were not effectively controlled. The encountered limitations included

  3. Anger and posttraumatic stress disorder in disaster relief workers exposed to the 9/11/01 World Trade Center Disaster: One-year follow-up study

    Science.gov (United States)

    Jayasinghe, Nimali; Giosan, Cezar; Evans, Susan; Spielman, Lisa; Difede, JoAnn

    2014-01-01

    While anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 (Evans et al., 2006) indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a one-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD. PMID:19008736

  4. Qualitative Methods in Patient-Centered Outcomes Research.

    Science.gov (United States)

    Vandermause, Roxanne; Barg, Frances K; Esmail, Laura; Edmundson, Lauren; Girard, Samantha; Perfetti, A Ross

    2017-02-01

    The Patient-Centered Outcomes Research Institute (PCORI), created to fund research guided by patients, caregivers, and the broader health care community, offers a new research venue. Many (41 of 50) first funded projects involved qualitative research methods. This study was completed to examine the current state of the science of qualitative methodologies used in PCORI-funded research. Principal investigators participated in phenomenological interviews to learn (a) how do researchers using qualitative methods experience seeking funding for, implementing and disseminating their work; and (b) how may qualitative methods advance the quality and relevance of evidence for patients? Results showed the experience of doing qualitative research in the current research climate as "Being a bona fide qualitative researcher: Staying true to research aims while negotiating challenges," with overlapping patterns: (a) researching the elemental, (b) expecting surprise, and (c) pushing boundaries. The nature of qualitative work today was explicitly described and is rendered in this article.

  5. Improvement of Coordination in the Multi-National Military Coordination Center of the Nepal Army in Respond to Disasters

    Science.gov (United States)

    2017-06-09

    protected by more restrictions in their home countries, in which case further publication or sale of copyrighted images is not permissible...Humanitarian Assistance on Disaster Management.” Thesis, Naval Postgraduate School , Monterey, CA, March. Mininistry of Home Affairs. 2013. National Disaster...effective coordinating mechanism. The research follows the case study method utilizing the Capability Based Analysis (CBA) approach to scrutinize the

  6. World Trade Center Disaster Exposure-Related Probable Posttraumatic Stress Disorder among Responders and Civilians: A Meta-Analysis

    Science.gov (United States)

    Liu, Bian; Tarigan, Lukman H.; Bromet, Evelyn J.; Kim, Hyun

    2014-01-01

    The World Trade Center (WTC) disaster on September 11, 2001 was an unprecedented traumatic event with long-lasting health consequences among the affected populations in the New York metropolitan area. This meta-analysis aimed to estimate the risk of probable posttraumatic stress disorder (PTSD) associated with specific types of WTC exposures. Meta-analytical findings from 10 studies of 3,271 to 20,294 participants yielded 37 relevant associations. The pooled summary odds ratio (OR) was 2.05 (95% confidence interval (CI): 1.82, 2.32), with substantial heterogeneity linked to exposure classification, cohort type, data source, PTSD assessment instrument/criteria, and lapse time since 9/11. In general, responders (e.g. police, firefighters, rescue/recovery workers and volunteers) had a lower probable PTSD risk (OR = 1.61; 95% CI: 1.39, 1.87) compared to civilians (e.g. residents, office workers, and passersby; OR = 2.71, 95% CI: 2.35, 3.12). The differences in ORs between responders and civilians were larger for physical compared to psychosocial exposure types. We also found that injury, lost someone, and witnessed horror were the three (out of six) most pernicious exposures. These findings suggest that these three exposures should be a particular focus in psychological evaluation and treatment programs in WTC intervention and future emergency preparedness efforts. PMID:25047411

  7. World Trade Center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Bian Liu

    Full Text Available The World Trade Center (WTC disaster on September 11, 2001 was an unprecedented traumatic event with long-lasting health consequences among the affected populations in the New York metropolitan area. This meta-analysis aimed to estimate the risk of probable posttraumatic stress disorder (PTSD associated with specific types of WTC exposures. Meta-analytical findings from 10 studies of 3,271 to 20,294 participants yielded 37 relevant associations. The pooled summary odds ratio (OR was 2.05 (95% confidence interval (CI: 1.82, 2.32, with substantial heterogeneity linked to exposure classification, cohort type, data source, PTSD assessment instrument/criteria, and lapse time since 9/11. In general, responders (e.g. police, firefighters, rescue/recovery workers and volunteers had a lower probable PTSD risk (OR = 1.61; 95% CI: 1.39, 1.87 compared to civilians (e.g. residents, office workers, and passersby; OR = 2.71, 95% CI: 2.35, 3.12. The differences in ORs between responders and civilians were larger for physical compared to psychosocial exposure types. We also found that injury, lost someone, and witnessed horror were the three (out of six most pernicious exposures. These findings suggest that these three exposures should be a particular focus in psychological evaluation and treatment programs in WTC intervention and future emergency preparedness efforts.

  8. Pulmonary function in a cohort of New York City Police Department emergency responders since the 2001 World Trade Center disaster.

    Science.gov (United States)

    Kleinman, Eli J; Cucco, Robert A; Martinez, Charles; Romanelli, John; Berkowitz, Israel; Lanes, Norman; Lichtenstein, David; Frazer, Somjen; Lit, M; Moran, William

    2011-06-01

    Comparing pulmonary function since the 2001 World Trade Center disaster, with preexposure data, in a New York City Police Department Emergency Responder cohort, without history of repetitive respiratory exposures. A total of 206 New York City Police Department Emergency Services Unit members reported Arrival Time, Exposure Location, Duration, Smoking History, Respirator Mask Usage, and Respiratory Symptoms, and underwent clinical evaluation and follow-up spirometry, in 2002 and 2007. A mean decline in forced vital capacity of 190 mL (3.7%) was observed 1-year postexposure in 2002, and 330 mL (6.4%) in 2007, compared with baseline data. Forced expiratory volume in the first second was not significantly changed in 2002 but declined 160 mL (3.9%) after 5 further years of follow-up. Abnormal spirometry was observed in (5.3%) of subjects, particularly individuals experiencing higher Exposure Intensity, Duration, or Respiratory Symptoms. The small number of smokers and subjects failing to wear protective respiratory masks showed greater declines.

  9. Forensic Archaeological Recovery of a Large-Scale Mass Disaster Scene: Lessons Learned from Two Complex Recovery Operations at the World Trade Center Site.

    Science.gov (United States)

    Warnasch, Scott C

    2016-05-01

    In 2006, unexpected discoveries of buried World Trade Center (WTC) debris and human remains were made at the World Trade Center mass disaster site. New York City's Office of Chief Medical Examiner (OCME) was given the task of systematically searching the site for any remaining victims' remains. The subsequent OCME assessment and archaeological excavation conducted from 2006 until 2013, resulted in the recovery of over 1,900 victims' remains. In addition, this operation demonstrated the essential skills archaeologists can provide in a mass disaster recovery operation. The OCME excavation data illustrates some of the challenges encountered during the original recovery effort of 2001/2002. It suggests that when understood within the larger site recovery context, certain fundamental components of the original recovery effort, such as operational priorities and activities in effect during the original recovery, directly or indirectly resulted in unsearched deposits that contained human remains. © 2016 American Academy of Forensic Sciences.

  10. Health effects of World Trade Center (WTC) Dust: An unprecedented disaster's inadequate risk management.

    Science.gov (United States)

    Lippmann, Morton; Cohen, Mitchell D; Chen, Lung-Chi

    2015-07-01

    The World Trade Center (WTC) twin towers in New York City collapsed on 9/11/2001, converting much of the buildings' huge masses into dense dust clouds of particles that settled on the streets and within buildings throughout Lower Manhattan. About 80-90% of the settled WTC Dust, ranging in particle size from ∼2.5 μm upward, was a highly alkaline mixture of crushed concrete, gypsum, and synthetic vitreous fibers (SVFs) that was readily resuspendable by physical disturbance and low-velocity air currents. High concentrations of coarse and supercoarse WTC Dust were inhaled and deposited in the conductive airways in the head and lungs, and subsequently swallowed, causing both physical and chemical irritation to the respiratory and gastroesophageal epithelia. There were both acute and chronic adverse health effects in rescue/recovery workers; cleanup workers; residents; and office workers, especially in those lacking effective personal respiratory protective equipment. The numerous health effects in these people were not those associated with the monitored PM2.5 toxicants, which were present at low concentrations, that is, asbestos fibers, transition and heavy metals, polyaromatic hydrocarbons or PAHs, and dioxins. Attention was never directed at the very high concentrations of the larger-sized and highly alkaline WTC Dust particles that, in retrospect, contained the more likely causal toxicants. Unfortunately, the initial focus of the air quality monitoring and guidance on exposure prevention programs on low-concentration components was never revised. Public agencies need to be better prepared to provide reliable guidance to the public on more appropriate means of exposure assessment, risk assessment, and preventive measures.

  11. Health effects of World Trade Center (WTC) Dust: An unprecedented disaster with inadequate risk management

    Science.gov (United States)

    Lippmann, Morton; Cohen, Mitchell D.; Chen, Lung-Chi

    2015-01-01

    The World Trade Center (WTC) twin towers in New York City collapsed on 9/11/2001, converting much of the buildings’ huge masses into dense dust clouds of particles that settled on the streets and within buildings throughout Lower Manhattan. About 80–90% of the settled WTC Dust, ranging in particle size from ~2.5 μm upward, was a highly alkaline mixture of crushed concrete, gypsum, and synthetic vitreous fibers (SVFs) that was readily resuspendable by physical disturbance and low-velocity air currents. High concentrations of coarse and supercoarse WTC Dust were inhaled and deposited in the conductive airways in the head and lungs, and subsequently swallowed, causing both physical and chemical irritation to the respiratory and gastroesophageal epithelia. There were both acute and chronic adverse health effects in rescue/recovery workers; cleanup workers; residents; and office workers, especially in those lacking effective personal respiratory protective equipment. The numerous health effects in these people were not those associated with the monitored PM2.5 toxicants, which were present at low concentrations, that is, asbestos fibers, transition and heavy metals, polyaromatic hydrocarbons or PAHs, and dioxins. Attention was never directed at the very high concentrations of the larger-sized and highly alkaline WTC Dust particles that, in retrospect, contained the more likely causal toxicants. Unfortunately, the initial focus of the air quality monitoring and guidance on exposure prevention programs on low-concentration components was never revised. Public agencies need to be better prepared to provide reliable guidance to the public on more appropriate means of exposure assessment, risk assessment, and preventive measures. PMID:26058443

  12. Aortic Center: specialized care improves outcomes and decreases mortality

    Directory of Open Access Journals (Sweden)

    Marcela da Cunha Sales

    2014-12-01

    Full Text Available Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA. Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%; and January/2008 to December/2010 (CTA, n=175, 52.7%. Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008, which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046, major complications (20.6 vs. 33.1%, P=0.007, stroke (4.6 vs. 10.9%, P=0.045 and sepsis (1.7 vs. 9.6%, P=0.001, as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007. CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049 and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037. Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008, urgent

  13. Management of resources at major incidents and disasters in relation to patient outcome: a pilot study of an educational model.

    Science.gov (United States)

    Nilsson, Heléne; Rüter, Anders

    2008-06-01

    Organizations involved in disaster response often have a defined operative level of management (command and control) that can take the overall decisions regarding the mobilization and distribution of resources and distribution of casualties. This level of management can be referred to as strategic management. The aim of this pilot study was to show the possibility, in simulation exercises, to relate decisions made regarding resources to patient outcome. The simulation system used measures to determine if lifesaving interventions are performed in time or not in relation to patient outcome. Evaluation was made with sets of performance indicators as templates and all management groups were evaluated not only as to how the decisions were made (management skills), but also how staff work was performed (staff procedure skills). Owing to inadequate response and insufficient distribution of patients to hospitals, 11 'patients' died in the simulated incident, a fire at a football stand with subsequent collapse. The strategic level of management received 16 points out of a possible 22 according to a predesigned template of performance indicators. The pilot study demonstrated the possibility to, in simulation exercises, relate decisions made regarding resources to patient outcome. This training technique could possibly lead to increased knowledge in what decisions are crucial to make in an early phase to minimize mortality and morbidity.

  14. Analysis of XXI Century Disasters in the National Geophysical Data Center Historical Natural Hazard Event Databases

    Science.gov (United States)

    Dunbar, P. K.; McCullough, H. L.

    2011-12-01

    The National Geophysical Data Center (NGDC) maintains a global historical event database of tsunamis, significant earthquakes, and significant volcanic eruptions. The database includes all tsunami events, regardless of intensity, as well as earthquakes and volcanic eruptions that caused fatalities, moderate damage, or generated a tsunami. Event date, time, location, magnitude of the phenomenon, and socio-economic information are included in the database. Analysis of the NGDC event database reveals that the 21st century began with earthquakes in Gujarat, India (magnitude 7.7, 2001) and Bam, Iran (magnitude 6.6, 2003) that killed over 20,000 and 31,000 people, respectively. These numbers were dwarfed by the numbers of earthquake deaths in Pakistan (magnitude 7.6, 2005-86,000 deaths), Wenchuan, China (magnitude 7.9, 2008-87,652 deaths), and Haiti (magnitude 7.0, 2010-222,000 deaths). The Haiti event also ranks among the top ten most fatal earthquakes. The 21st century has observed the most fatal tsunami in recorded history-the 2004 magnitude 9.1 Sumatra earthquake and tsunami that caused over 227,000 deaths and 10 billion damage in 14 countries. Six years later, the 2011 Tohoku, Japan earthquake and tsunami, although not the most fatal (15,000 deaths and 5,000 missing), could cost Japan's government in excess of 300 billion-the most expensive tsunami in history. Volcanic eruptions can cause disruptions and economic impact to the airline industry, but due to their remote locations, fatalities and direct economic effects are uncommon. Despite this fact, the second most expensive eruption in recorded history occurred in the 21st century-the 2010 Merapi, Indonesia volcanic eruption that resulted in 324 deaths, 427 injuries, and $600 million in damage. NGDC integrates all natural hazard event datasets into one search interface. Users can find fatal tsunamis generated by earthquakes or volcanic eruptions. The user can then link to information about the related runup

  15. Posttraumatic stress symptoms after exposure to two fire disasters: comparative study.

    Science.gov (United States)

    Van Loey, Nancy E; van de Schoot, Rens; Faber, Albertus W

    2012-01-01

    This study investigated traumatic stress symptoms in severely burned survivors of two fire disasters and two comparison groups of patients with "non-disaster" burn injuries, as well as risk factors associated with acute and chronic stress symptoms. Patients were admitted to one out of eight burn centers in The Netherlands or Belgium. The Impact of Event Scale (IES) was administered to 61 and 33 survivors respectively of two fire disasters and 54 and 57 patients with "non-disaster" burn etiologies at 2 weeks, 3, 6, 12 and 24 months after the event. We used latent growth modeling (LGM) analyses to investigate the stress trajectories and predictors in the two disaster and two comparison groups. The results showed that initial traumatic stress reactions in disaster survivors with severe burns are more intense and prolonged during several months relative to survivors of "non-disaster" burn injuries. Excluding the industrial fire group, all participants' symptoms on average decreased over the two year period. Burn severity, peritraumatic anxiety and dissociation predicted the long-term negative outcomes only in the industrial fire group. In conclusion, fire disaster survivors appear to experience higher levels of traumatic stress symptoms on the short term, but the long-term outcome appears dependent on factors different from the first response. Likely, the younger age, and several beneficial post-disaster factors such as psychosocial aftercare and social support, along with swift judicial procedures, contributed to the positive outcome in one disaster cohort.

  16. Trauma-Focused Smoking Cessation for Smokers Exposed to the World Trade Center Disaster: A Randomized Clinical Trial.

    Science.gov (United States)

    Gonzalez, Adam; Friedberg, Fred; Li, Xiaotong; Zvolensky, Michael J; Bromet, Evelyn J; Mahaffey, Brittain L; Vujanovic, Anka A; Luft, Benjamin J; Kotov, Roman

    2017-08-01

    The main objective was to evaluate the efficacy of an 8-session, group-based comprehensive smoking cessation and trauma management (CSC-T) treatment among daily smokers (≥5 cigarettes/day) exposed to the World Trade Center (WTC) disaster with elevated WTC-related post-traumatic stress disorder (PTSD) symptoms. Participants (N = 90) were randomly assigned to CSC-T (N = 44; 63.6% white; 27.3% female; mean age = 51.32 ± 7.87) or comprehensive smoking cessation (CSC) alone (N = 46; 71.7% white; 28.3% female; mean age = 48.74 ± 10.66), which was comparable in length and time. Assessments included a diagnostic clinical interview and self-report measures of PTSD and respiratory symptoms, and smoking behavior, and biologically confirmed smoking abstinence. Evaluations occurred at a baseline visit, each treatment session, and at 1-, 2-, 4-, 12-, and 26-weeks post-treatment. The two treatments did not differ in regard to PTSD symptom improvement. After quit day (week 6), the two groups had similar 7-day (~15%) and 6-month (~20%) abstinence rates as well as average number of cigarettes smoked, and PTSD and respiratory symptoms. It is possible that the Cognitive Behavioral Therapy skills specific to quitting smoking, group-based support, and degree of therapist contact, that were available in both treatments may have played a role in equalizing the abstinence rates between the two conditions. Although the current study found no evidence that the CSC-T was superior to the CSC alone treatment, the abstinence rates observed were high relative to previous trials of smokers with diagnosed PTSD. Further development of smoking cessation programs tailored to the needs of smokers with PTSD symptoms continues to be needed. This study suggests that a CSC program aids in smoking abstinence for smokers with PTSD symptoms and that incorporating trauma management skills, may not add additional benefits for abstinence and PTSD and respiratory symptom relief. Further work is needed to

  17. 75 FR 59720 - Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI)

    Science.gov (United States)

    2010-09-28

    ... GOVERNMENT ACCOUNTABILITY OFFICE Methodology Committee of the Patient-Centered Outcomes Research... responsibility for appointing not more than 15 members to a Methodology Committee of the Patient- Centered Outcomes Research Institute. In addition, the Directors of the Agency for Healthcare Research and Quality...

  18. Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial.

    Science.gov (United States)

    Desai, Atman; Bekelis, Kimon; Ball, Perry A; Lurie, Jon; Mirza, Sohail K; Tosteson, Tor D; Zhao, Wenyan; Weinstein, James N

    2013-04-15

    Retrospective review of a prospectively collected database. To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers. Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated. Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed. A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (Short Form-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with Short Form-36 scores trending toward significance. There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures, although further studies are required to investigate which

  19. Disaster Research

    DEFF Research Database (Denmark)

    Given the tendency of books on disasters to predominantly focus on strong geophysical or descriptive perspectives and in-depth accounts of particular catastrophes, Disaster Research provides a much-needed multidisciplinary perspective of the area. This book is is structured thematically around key...... approaches to disaster research from a range of different, but often complementary academic disciplines. Each chapter presents distinct approaches to disaster research that is anchored in a particular discipline; ranging from the law of disasters and disaster historiography to disaster politics...... and anthropology of disaster. The methodological and theoretical contributions underlining a specific approach to disasters are discussed and illustrative empirical cases are examined that support and further inform the proposed approach to disaster research. The book thus provides unique insights into fourteen...

  20. Trainees versus Staff: Exploring Counseling Outcomes in a College Counseling Center

    Science.gov (United States)

    Ilagan, Guy; Vinson, Mike; Sharp, Julia L.; Havice, Pamela; Ilagan, Jill

    2014-01-01

    Investigators compared counseling outcomes among nonpaid graduate-level trainees and professional staff at a college counseling center. Counseling outcomes for 331 college student participants were measured using the Outcome Questionnaire 45.2 (OQ45.2), employing a pretest--posttest design. The two groups of service providers did not differ…

  1. A person-centered analysis of posttraumatic stress disorder symptoms following a natural disaster: predictors of latent class membership.

    Science.gov (United States)

    Rosellini, Anthony J; Coffey, Scott F; Tracy, Melissa; Galea, Sandro

    2014-01-01

    The present study applied latent class analysis to a sample of 810 participants residing in southern Mississippi at the time of Hurricane Katrina to determine if people would report distinct, meaningful PTSD symptom classes following a natural disaster. We found a four-class solution that distinguished persons on the basis of PTSD symptom severity/pervasiveness (Severe, Moderate, Mild, and Negligible Classes). Multinomial logistic regression models demonstrated that membership in the Severe and Moderate Classes was associated with potentially traumatic hurricane-specific experiences (e.g., being physically injured, seeing dead bodies), pre-hurricane traumatic events, co-occurring depression symptom severity and suicidal ideation, certain religious beliefs, and post-hurricane stressors (e.g., social support). Collectively, the findings suggest that more severe/pervasive typologies of natural disaster PTSD may be predicted by the frequency and severity of exposure to stressful/traumatic experiences (before, during, and after the disaster), co-occurring psychopathology, and specific internal beliefs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. When is a natural disaster a development disaster; when is a natural disaster not a disaster?

    Science.gov (United States)

    Mutter, J. C.; Archibong, B.; Pi, D.

    2009-12-01

    Extremes of nature like hurricanes, droughts and earthquakes influence human welfare in a variety of ways. While it might seem counterintuitive, evidence from long run macro-economic data suggests that when natural extremes are especially destructive to human societies, and earn the title “natural disaster” they can actually have a beneficial effect on development. The process involved may be akin to the “The gale of creative destruction” first described by the economist Joseph Schumpeter. Applied to disasters the notion is that, in the short term, disasters can stimulate certain industries such as construction with capital flows coming into the disaster region from outside sources such as central government or international aid that can stimulate the economy. Longer term, outdated and inefficient public and private infrastructure destroyed in the disaster can be replaced by up to date, efficient systems that permit the economy to function more effectively, so that post-disaster growth can exceed pre-disaster levels. Disasters are macro-economic shocks, fundamentally similar to the banking shock that lead to the current global recession and, in the same way require external capital stimuli to overcome and that stimulus can result in stronger economies after recovery. These large-scale and long-run trends disguise the fact that disasters have very different development outcomes for different societies. Globally, there is evidence that poorer countries are not systematically stimulated by disaster shocks and may even be driven into poverty traps by certain disasters. Locally, the recovery from Hurricane Katrina in New Orleans has had been very different for different social groups, with both over-recovery and under-recovery occurring simultaneously and in close proximity. We discuss the conditions under which disasters might be a stimulating force and when they might lead to development setbacks.

  3. 'The patient': at the center of patient-reported outcomes.

    Science.gov (United States)

    Awad, A George

    2015-08-09

    The recent emphasis of including patient reports in their own care management is reviewed in terms of the factors that contributed to its popularity. The role change of patients as being active participants in their own care as a result of the rising consumerism and advocacy has led to increased pressures for including patients in the therapeutic decision-making process. As consumers of clinical services, their perspectives and attitudes towards health and illness acquired more importance. The rising cost of healthcare has added another dimension in cost containment by empowering patients and sharing responsibility in their recovery, which hopefully can improve outcomes. Challenges in the development and implementation of patient-reported outcomes in psychiatry are reviewed and include the still unresolved subjective/objective dichotomy, identification of the most appropriate and relevant patient-reported outcomes. Few outcomes are identified and include: subjective tolerability of medication, self-reported health-related quality of life, preferences, patients' attitudes towards health and illness, satisfaction with medication and overall satisfaction of quality of care, and functional state, with particular focus on social functioning.

  4. Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.

    Science.gov (United States)

    Jordan, Hannah T; Stellman, Steven D; Morabia, Alfredo; Miller-Archie, Sara A; Alper, Howard; Laskaris, Zoey; Brackbill, Robert M; Cone, James E

    2013-10-24

    A cohort study found that 9/11-related environmental exposures and posttraumatic stress disorder increased self-reported cardiovascular disease risk. We attempted to replicate these findings using objectively defined cardiovascular disease hospitalizations in the same cohort. Data for adult World Trade Center Health Registry enrollees residing in New York State on enrollment and no cardiovascular disease history (n = 46,346) were linked to a New York State hospital discharge-reporting system. Follow-up began at Registry enrollment (2003-2004) and ended at the first cerebrovascular or heart disease (HD) hospitalization, death, or December 31, 2010, whichever was earliest. We used proportional hazards models to estimate adjusted hazard ratios (AHRs) for HD (n = 1151) and cerebrovascular disease (n = 284) hospitalization during 302,742 person-years of observation (mean follow-up, 6.5 years per person), accounting for other factors including age, race/ethnicity, smoking, and diabetes. An elevated risk of HD hospitalization was observed among women (AHR 1.32, 95% CI 1.01 to 1.71) but not men (AHR 1.16, 95% CI 0.97 to 1.40) with posttraumatic stress disorder at enrollment. A high overall level of World Trade Center rescue and recovery-related exposure was associated with an elevated HD hospitalization risk in men (AHR 1.82, 95% CI 1.06 to 3.13; P for trend = 0.05), but findings in women were inconclusive (AHR 3.29, 95% CI 0.85 to 12.69; P for trend = 0.09). Similar associations were observed specifically with coronary artery disease hospitalization. Posttraumatic stress disorder increased the cerebrovascular disease hospitalization risk in men but not in women. 9/11-related exposures and posttraumatic stress disorder appeared to increase the risk of subsequent hospitalization for HD and cerebrovascular disease. This is consistent with findings based on self-reported outcomes.

  5. Emergency Wound Care After a Natural Disaster

    Science.gov (United States)

    ... About CDC.gov . Natural Disasters and Severe Weather Earthquakes Being Prepared Emergency Supplies Home Hazards Indoor Safety ... Are You Prepared? Information for Specific Groups Disaster Evacuation Centers Infection Control Infection Control Guidance for Community ...

  6. Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies.

    Science.gov (United States)

    Wong, Diana F; Spencer, Caroline; Boyd, Lee; Burkle, Frederick M; Archer, Frank

    2017-10-01

    Introduction The frequency of disasters is increasing around the world with more people being at risk. There is a moral imperative to improve the way in which disaster evaluations are undertaken and reported with the aim of reducing preventable mortality and morbidity in future events. Disasters are complex events and undertaking disaster evaluations is a specialized area of study at an international level. Hypothesis/Problem While some frameworks have been developed to support consistent disaster research and evaluation, they lack validation, consistent terminology, and standards for reporting across the different phases of a disaster. There is yet to be an agreed, comprehensive framework to structure disaster evaluation typologies. The aim of this paper is to outline an evolving comprehensive framework for disaster evaluation typologies. It is anticipated that this new framework will facilitate an agreement on identifying, structuring, and relating the various evaluations found in the disaster setting with a view to better understand the process, outcomes, and impacts of the effectiveness and efficiency of interventions. Research was undertaken in two phases: (1) a scoping literature review (peer-reviewed and "grey literature") was undertaken to identify current evaluation frameworks and typologies used in the disaster setting; and (2) a structure was developed that included the range of typologies identified in Phase One and suggests possible relationships in the disaster setting. No core, unifying framework to structure disaster evaluation and research was identified in the literature. The authors propose a "Comprehensive Framework for Disaster Evaluation Typologies" that identifies, structures, and suggests relationships for the various typologies detected. The proposed Comprehensive Framework for Disaster Evaluation Typologies outlines the different typologies of disaster evaluations that were identified in this study and brings them together into a single

  7. Outcome Variation Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis

    Science.gov (United States)

    Desai, Atman; Bekelis, Kimon; Ball, Perry A.; Lurie, Jon; Mirza, Sohail K.; Tosteson, Tor D.; Zhao, Wenyan; Weinstein, James N.

    2014-01-01

    Study Design Retrospective review of a prospectively collected database. Objective To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers. Summary of Background Data Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated. Methods Spine patient outcomes research trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed. Results A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (SF-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with SF-36 scores trending toward significance. Conclusion There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures

  8. Posttraumatic stress symptoms and body mass index among World Trade Center disaster-exposed smokers: A preliminary examination of the role of anxiety sensitivity.

    Science.gov (United States)

    Farris, Samantha G; Paulus, Daniel J; Gonzalez, Adam; Mahaffey, Brittain L; Bromet, Evelyn J; Luft, Benjamin J; Kotov, Roman; Zvolensky, Michael J

    2016-07-30

    Among individuals exposed to the World Trade Center (WTC) disaster on September 11, 2001, posttraumatic stress disorder (PTSD) and symptoms are both common and associated with increased cigarette smoking and body mass. However, there is little information on the specific processes underlying the relationship of PTSD symptoms with body mass. The current study is an initial exploratory test of anxiety sensitivity, the fear of internal bodily sensations, as a possible mechanism linking PTSD symptom severity and body mass index (BMI). Participants were 147 adult daily smokers (34.0% female) exposed to the WTC disaster (via rescue/recovery work or direct witness). The direct and indirect associations between PTSD symptom severity and BMI via anxiety sensitivity (total score and subscales of physical, cognitive, and social concerns) were examined. PTSD symptom severity was related to BMI indirectly via anxiety sensitivity; this effect was specific to physical concerns about the meaning of bodily sensations. Interventions focusing on anxiety sensitivity reduction (specifically addressing physical concerns about bodily sensations) may be useful in addressing elevated BMI among trauma-exposed persons. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Exploring Outcomes and Initial Self-Report of Client Motivation in a College Counseling Center

    Science.gov (United States)

    Ilagan, Guy; Vinson, Michael L.; Sharp, Julia L.; Ilagan, Jill; Oberman, Aaron

    2015-01-01

    Objective: To explore the association between college counseling center clients' initial self-report of motivation and counseling outcome. Participants: The sample was composed of 331 student clients who utilized a college counseling center from August 2007 to August 2009. The college is a public, mid-size, urban university in the Southeast.…

  10. The Utility of an Efficient Outcomes Assessment System at University Counseling Centers

    Science.gov (United States)

    Kopta, S. Mark; Petrik, Megan L.; Saunders, Stephen M.; Mond, Michael; Hirsch, Glenn; Kadison, Richard; Raymond, Danielle

    2014-01-01

    Due to increased demands placed on university counseling centers (UCCs) in recent years, there is a need for these centers to enhance the efficiency and effectiveness of their psychological services. Regularly monitoring client progress is one approach to increase the likelihood of positive clinical outcomes. This article describes the use of the…

  11. DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11).

    Science.gov (United States)

    Bromet, E J; Hobbs, M J; Clouston, S A P; Gonzalez, A; Kotov, R; Luft, B J

    2016-03-01

    Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

  12. Eyes of the Storm: Can Fusion Centers Play a Crucial Role During the Response Phase of Natural Disasters Through Collaborative Relationships With Emergency Operations Centers?

    Science.gov (United States)

    2014-09-01

    Capabilities for State and Major Urban Area Fusion Centers, A Supplement to the Fusion Center Guidelines (Washington, DC: Global Justice Information...been linear. Their mission sprawl has entered into areas already covered by other disciplines. The fusion center is more than a physical location... cause and effect over time.59 The relation of these two concepts creates a mechanism that can address difficult problems. In essence, the system

  13. A viewpoint on the impact of device advisories on patient-centered outcomes

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Berg, Martha; Theuns, Dominic A M J

    2009-01-01

    Device advisories due to potential hardware failure comprise one of the downsides of implantable cardioverter defibrillator (ICD) therapy. The impact of advisories on patient-centered outcomes has largely been overlooked. We examined the impact of ICD advisories on patient-centered outcomes via...... a systematic literature review. PubMed was searched in the period from 1980 to present using a combination of at set of a priori search terms. The reference lists of the included papers were searched by hand. A total of six studies were identified. All advisories were Class I, Class II, or a combination....... The sample size across studies varied between 30 and 86 patients subject to an advisory; four of six studies used a case-control design and two of six a prospective study design. There was considerable variability between notification of the advisory and assessment of the patient-centered outcomes, ranging...

  14. The International Dermatology Outcome Measures Group: formation of patient-centered outcome measures in dermatology.

    Science.gov (United States)

    Gottlieb, Alice B; Levin, Adriane A; Armstrong, April W; Abernethy, April; Duffin, Kristina Callis; Bhushan, Reva; Garg, Amit; Merola, Joseph F; Maccarone, Mara; Christensen, Robin

    2015-02-01

    As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. FEMA Current Disaster Declarations -shp

    Data.gov (United States)

    Department of Homeland Security — This dataset lists the current Disaster Declarations in Shapefile. This data was compiled and distributed by FEMA Mapping and Analysis Center (MAC). Metadata file...

  16. The Integrated Information System for Natural Disaster Mitigation

    Directory of Open Access Journals (Sweden)

    Junxiu Wu

    2007-08-01

    Full Text Available Supported by the World Bank, the Integrated Information System for Natural Disaster Mitigation (ISNDM, including the operational service system and network telecommunication system, has been in development for three years in the Center of Disaster Reduction, Chinese Academy of Sciences, based on the platform of the GIS software Arcview. It has five main modules: disaster background information, socio- economic information, disaster-induced factors database, disaster scenarios database, and disaster assessment. ISNDM has several significant functions, which include information collection, information processing, data storage, and information distribution. It is a simple but comprehensive demonstration system for our national center for natural disaster reduction.

  17. Chronic and acute exposures to the world trade center disaster and lower respiratory symptoms: area residents and workers.

    Science.gov (United States)

    Maslow, Carey B; Friedman, Stephen M; Pillai, Parul S; Reibman, Joan; Berger, Kenneth I; Goldring, Roberta; Stellman, Steven D; Farfel, Mark

    2012-06-01

    We assessed associations between new-onset (post-September 11, 2001 [9/11]) lower respiratory symptoms reported on 2 surveys, administered 3 years apart, and acute and chronic 9/11-related exposures among New York City World Trade Center-area residents and workers enrolled in the World Trade Center Health Registry. World Trade Center-area residents and workers were categorized as case participants or control participants on the basis of lower respiratory symptoms reported in surveys administered 2 to 3 and 5 to 6 years after 9/11. We created composite exposure scales after principal components analyses of detailed exposure histories obtained during face-to-face interviews. We used multivariate logistic regression models to determine associations between lower respiratory symptoms and composite exposure scales. Both acute and chronic exposures to the events of 9/11 were independently associated, often in a dose-dependent manner, with lower respiratory symptoms among individuals who lived and worked in the area of the World Trade Center. Study findings argue for detailed assessments of exposure during and after events in the future from which potentially toxic materials may be released and for rapid interventions to minimize exposures and screen for potential adverse health effects.

  18. Physical and mental health of disaster victims: a comparative study on typhoon and oil spill disasters.

    Science.gov (United States)

    Chung, Soondool; Kim, Eunjeong

    2010-09-01

    The purpose of this study was to compare the physical and mental health status of disaster victims according to disaster types, such as a typhoon disaster and an oil spill disaster, and to suggest adequate health care services for them. A total of 484 people who suffered disasters were selected for this study, and data were collected from July to August, 2008. The data-set for this study included 286 victims of typhoon disasters in Jeju and Jeollanamdo district in South Korea, and 198 victims of the oil spill disaster in Taean. Physical health status was measured using revised Patient Health Questionnaire and mental health status was measured using the Korean version of 'Post-traumatic Diagnostic Scale'. According to the comparative analyses of typhoon disaster victims and oil spill disaster victims, poorer physical health outcomes were shown among the oil spill disaster victims when compared to the typhoon disaster victims. Also, the oil spill disaster victims showed symptoms of depression, anxiety, and post-traumatic stress disorder, at rates higher than those found among the typhoon disaster victims. These findings suggest that there is a need to provide adequate physical and mental health-related care services for oil spill disaster victims. The seriousness of oil spill disaster should be realized and reconsidered in developing recovery strategies and disaster preparedness for physical and mental health services.

  19. "Delay to operating room" fails to identify adverse outcomes at a Level I trauma center.

    Science.gov (United States)

    Lewis, Paul R; Badiee, Jayraan; Sise, Michael J; Calvo, Richard Y; Brill, Jason B; Wallace, James D; Shackford, Steven R; Dunne, Casey E; Bansal, Vishal; Sise, C Beth

    2017-02-01

    The American College of Surgeons Committee on Trauma devised process audit filters to identify opportunities for improvement (OFI), prevent adverse outcomes, and improve quality. Delay to the operating room for primary trauma laparotomy is a process audit filter that has not been definitively associated with improved outcomes. We sought to evaluate the effectiveness of delay to the operating room of greater than 2 hours (DOR) to independently identify an adverse outcome or an OFI at our Level I trauma center. Trauma patients who underwent primary exploratory laparotomy from July 2006 to March 2015 were reviewed. Those with DOR were identified and compared with those without DOR. To analyze the ability of DOR to independently identify an adverse outcome or an OFI, DOR patients were further divided into those with isolated DOR and those with DOR in conjunction with one or more other process audit filter. Primary outcome was the presence of a complication. Secondary outcome was an identified OFI. Medical records of patients with either outcome were reviewed to determine if the outcome resulted directly from DOR. Of 472 patients, 109 (23%) had DOR and 363 (77%) did not. There were no significant differences in age, sex, or injury severity between the two groups. The rates of complications among DOR patients and those without DOR were not significantly different (35% vs. 38%, p = 0.59). The DOR was the only process audit filter flagged in 31(28%) patients in the DOR group. This subgroup had no identified complications but incurred two OFIs; neither OFI was associated with an adverse outcome. In trauma patients undergoing primary exploratory laparotomy, DOR fails to independently identify adverse outcomes. These findings suggest that DOR, as a routinely collected process audit filter, is not an effective indicator of suboptimal care or adverse outcomes at a Level I trauma center. Therapeutic study, level IV; prognostic study, level III.

  20. Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures

    Directory of Open Access Journals (Sweden)

    Mallory Devon

    2006-11-01

    Full Text Available Abstract Background Central to the development of a sound evidence base for Complementary and Alternative Medicine (CAM interventions is the need for valid, reliable and relevant outcome measures to assess whether the interventions work. We assessed the specific needs for a database that would cover a wide range of outcomes measures for CAM research and considered a framework for such a database. Methods The study was a survey of CAM researchers, practitioners and students. An online questionnaire was emailed to the members of the Canadian Interdisciplinary Network for CAM Research (IN-CAM and the CAM Education and Research Network of Alberta (CAMera. The majority of survey questions were open-ended and asked about outcome measures currently used, outcome measures' assessment criteria, sources of information, perceived barriers to finding outcome measures and outcome domains of importance. Descriptive quantitative analysis and qualitative content analysis were used. Results One hundred and sixty-four completed surveys were received. Of these, 62 respondents reported using outcome measures in their CAM research and identified 92 different specific outcomes. The most important barriers were the fact that, for many health concepts, outcome measures do not yet exist, as well as issues related to accessibility of instruments. Important outcome domains identified included physical, psychological, social, spiritual, quality of life and holistic measures. Participants also mentioned the importance of individualized measures that assess unique patient-centered outcomes for each research participant, and measures to assess the context of healing and the process of healing. Conclusion We have developed a preliminary framework that includes all components of health-related outcomes. The framework provides a foundation for a larger, comprehensive collection of CAM outcomes. It fits very well in a whole systems perspective, which requires an expanded set of

  1. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Van Den Broek, Krista C; Van Den Berg, Martha

    2010-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are well established, but ICD shocks are known to influence patient-centered outcomes. In this viewpoint, we examine the strength of the evidence as found in primary and secondary prevention trials that used quality of life...... as an outcome, and compare the influence of ICD shock with other factors (e.g., heart failure and psychological factors) as determinants of outcomes, with a view to providing recommendations for clinical practice and future research. Based on the large-scale primary and secondary prevention trials (i.e., CABG...

  2. Predictors of psychotherapy outcome for children at a community mental health center.

    Science.gov (United States)

    Bush, R M; Glenwick, D S; Stephens, M A

    1986-11-01

    This study assessed the utility of multiple predictors of outcome for 268 child clients and their families who received psychotherapy at a community mental health center for children. Outcome was measured by the number of therapy sessions attended, the length of therapy, and improvement ratings of the child and family made by independent judges. Regression analyses revealed that the strongest predictors of outcome were previous exposure to therapy, therapist type (permanent professional staff vs. intern), family constellation, therapist experience, and referral source. Implications for treatment planning and future research are discussed.

  3. Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

    Science.gov (United States)

    Winkelmayer, Wolfgang C.; Wheeler, David C.; van Biesen, Wim; Tugwell, Peter; Manns, Braden; Hemmelgarn, Brenda; Harris, Tess; Crowe, Sally; Ju, Angela; O’Lone, Emma; Evangelidis, Nicole; Craig, Jonathan C.

    2017-01-01

    Background and objectives Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists’ perspectives on defining and implementing patient-centered outcomes in hemodialysis. Design, setting, participants, & measurements Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. Results We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). Conclusions Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader

  4. Outcome of Cushing's disease following transsphenoidal surgery in a single center over 20 years.

    LENUS (Irish Health Repository)

    Hassan-Smith, Zaki K

    2012-04-01

    Historically, Cushing\\'s disease (CD) was associated with a 5-yr survival of just 50%. Although advances in CD management have seen mortality rates improve, outcome from transsphenoidal surgery (TSS), the current first-line treatment, varies significantly between centers.

  5. Games Centered Approaches in Teaching Children & Adolescents: Systematic Review of Associated Student Outcomes

    Science.gov (United States)

    Miller, Andrew

    2015-01-01

    The purpose of this systematic review was to investigate the weight of scientific evidence regarding student outcomes (physical, cognitive and affective) of a Game Centered Approach (GCA) when the quality of a study was taken into account in the interpretation of collective findings. A systematic search of five electronic databases (Sports…

  6. Can Physical Education and Physical Activity Outcomes Be Developed Simultaneously Using a Game-Centered Approach?

    Science.gov (United States)

    Miller, Andrew; Christensen, Erin; Eather, Narelle; Gray, Shirley; Sproule, John; Keay, Jeanne; Lubans, David

    2016-01-01

    The primary objective of this study was to evaluate the efficacy of a pilot intervention using a game-centered approach for improvement of physical activity (PA) and physical education (PE) outcomes simultaneously, and if this had an impact on enjoyment of PE. A group-randomized controlled trial with a 7-week wait-list control group was conducted…

  7. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)

    2015-01-01

    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  8. Human identification following the World Trade Center disaster: assessing management practices for highly fragmented and commingled human remains

    OpenAIRE

    Mundorff, Amy

    2009-01-01

    This study is a retrospective analysis of major management decisions, particularly those that involved anthropology, made during the World Trade Center human identification project. The objective is to understand why certain decisions were made and to access how those decisions affected the overall identification project from the perspective of increased efficiency, accuracy, and by increasing the number of identifications. Based on these results and insights, a list of recommendations is pro...

  9. The BEYOND center of excellence for the effective exploitation of satellite time series towards natural disasters monitoring and assessment

    Science.gov (United States)

    Kontoes, Charalampos; Papoutsis, Ioannis; Amiridis, Vassilis; Balasis, George; Keramitsoglou, Iphigenia; Herekakis, Themistocles; Christia, Eleni

    2014-05-01

    BEYOND project (2013-2016, 2.3Meuro) funded under the FP7-REGPOT scheme is an initiative which aims to build a Centre of Excellence for Earth Observation (EO) based monitoring of natural disasters in south-eastern Europe (http://beyond-eocenter.eu/), established at the National Observatory of Athens (NOA). The project focuses on capacity building on top of the existing infrastructure, aiming at unlocking the institute's potential through the systematic interaction with high-profile partners across Europe, and at consolidating state-of-the-art equipment and technological know-how that will allow sustainable cutting-edge interdisciplinary research to take place with an impact on the regional and European socioeconomic welfare. The vision is to set up innovative integrated observational solutions to allow a multitude of space borne and ground-based monitoring networks to operate in a complementary and cooperative manner, create archives and databases of long series of observations and higher level products, and make these available for exploitation with the involvement of stakeholders. In BEYOND critical infrastructural components are being procured for fostering access, use, retrieval and analysis of long EO data series and products. In this framework NOA has initiated activities for the development, installation and operation of important acquisition facilities and hardware modules, including space based observational infrastructures as the X-/L-band acquisition station for receiving EOS Aqua/Terra, NPP, JPSS, NOAA, Metop, Feng Yun data in real time, the setting up of an ESA's Mirror Site of Sentinel missions to be operable from 2014 onwards, an advanced Raman Lidar portable station, a spectrometer facility, several ground magnetometer stations. All these are expected to work in synergy with the existing capacity resources and observational networks including the MSG/SEVIRI acquisition station, nationwide seismographic, GPS, meteo and atmospheric networks. The

  10. An Evaluation of Army Wellness Center Clients' Health-Related Outcomes.

    Science.gov (United States)

    Rivera, L Omar; Ford, Jessica Danielle; Hartzell, Meredith Marie; Hoover, Todd Allan

    2018-01-01

    To examine whether Army community members participating in a best-practice based workplace health promotion program (WHPP) experience goal-moderated improvements in health-related outcomes. Pretest/posttest outcome evaluation examining an autonomously participating client cohort over 1 year. Army Wellness Center facilities on 19 Army installations. Army community members sample (N = 5703), mostly Active Duty Soldiers (64%). Assessment of health risks with feedback, health assessments, health education classes, and health coaching sessions conducted by health educators at a recommended frequency of once a month for 3 to 12 months. Initial and follow-up outcome assessments of body mass index (BMI), body fat, cardiorespiratory fitness, blood pressure, and perceived stress. Mixed model linear regression testing for goal-moderated improvements in outcomes. Clients experienced significant improvements in body fat (-2% change), perceived stress (-6% to -12% change), cardiorespiratory fitness (+6% change), and blood pressure (-1% change) regardless of health-related goal. Only clients with a weight loss goal experienced BMI improvement (-1% change). Follow-up outcome assessment rates ranged from 44% (N = 2509) for BMI to 6% (N = 342) for perceived stress. Army Wellness Center clients with at least 1 follow-up outcome assessment experienced improvements in military readiness correlates and chronic disease risk factors. Evaluation design and follow-up-related limitations notwithstanding results suggest that best practices in WHPPs can effectively serve a globally distributed military force.

  11. Disaster medicine. Mental care

    International Nuclear Information System (INIS)

    Haginoya, Masato; Shimoda, Kazutaka

    2012-01-01

    Described are 5 essential comments of view concerning the post-disaster psychiatric care through authors' experience at the aid of the 2011 Tohoku Earthquake and Tsunami including Fukushima Daiichi Nuclear Power Plant Accident. Firstly, at the acute phase of disaster, the ensured safe place, sleep and rest are necessary as a direct aid of sufferers and their family. Insomnia is seen in many of them and can partly be a prodrome of disorders like post traumatic stress disorder (PTSD). US Psychological First Aid (PFA) is useful for a guide of the initial aid for disaster, and translated Japanese version is available free. Public anxiety as a psychological effect can be caused even out of the disaster-stricken area by such factors as on-site news reports (inducing identification), internet information, economical and social confusion, forecasted radiation hazard, etc. Cool-headed understanding is required for them and particularly for complicated radiological information. The system for psychiatric treatment is needed as exemplified by its temporary lack due to the radiation disaster near the Plant and consequent prompt dispatch of psychiatrists from Dokkyo Medical University. Survived sufferers' grief and bereavement are said to tend to last long, to be complicated and deteriorated, indicating the necessity of management of continuous mental health. Alcoholism as a result to avoid those feelings should be noted. Finally, pointed out is the mental care for supporters working for recovery from the disaster, like policeman, Self-Defense Force member, fireman, doctor, nurse, officer, volunteer and many others concerned, because PTSD prevalence is reported to amount to 12.4% of rescue and recovery workers of US World Trade Center Disaster (9.11) even 2-3 years after. (T.T.)

  12. Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

    Science.gov (United States)

    Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

    2017-04-01

    Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  13. Patient-centered outcomes research in radiology: trends in funding and methodology.

    Science.gov (United States)

    Lee, Christoph I; Jarvik, Jeffrey G

    2014-09-01

    The creation of the Patient-Centered Outcomes Research Trust Fund and the Patient-Centered Outcomes Research Institute (PCORI) through the Patient Protection and Affordable Care Act of 2010 presents new opportunities for funding patient-centered comparative effectiveness research (CER) in radiology. We provide an overview of the evolution of federal funding and priorities for CER with a focus on radiology-related priority topics over the last two decades, and discuss the funding processes and methodological standards outlined by PCORI. We introduce key paradigm shifts in research methodology that will be required on the part of radiology health services researchers to obtain competitive federal grant funding in patient-centered outcomes research. These paradigm shifts include direct engagement of patients and other stakeholders at every stage of the research process, from initial conception to dissemination of results. We will also discuss the increasing use of mixed methods and novel trial designs. One of these trial designs, the pragmatic trial, has the potential to be readily applied to evaluating the effectiveness of diagnostic imaging procedures and imaging-based interventions among diverse patient populations in real-world settings. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  14. Establishing a health outcomes and economics center in radiology: strategies and resources required

    International Nuclear Information System (INIS)

    Medina, Santiago L.; Altman, Nolan R.

    2002-01-01

    To describe the resources and strategies required to establish a health outcomes and economics center in radiology.Methods. Human and nonhuman resources required to perform sound outcomes and economics studies in radiology are reviewed.Results. Human resources needed include skilled medical and nonmedical staff. Nonhuman resources required are: (1) communication and information network; (2) education tools and training programs; (3) budgetary strategies; and (4) sources of income. Effective utilization of these resources allows the performance of robust operational and clinical research projects in decision analysis, cost-effectiveness, diagnostic performance (sensitivity, specificity, and ROC curves), and clinical analytical and experimental studies.Conclusion. As new radiologic technology and techniques are introduced in medicine, society is increasingly demanding sound clinical studies that will determine the impact of radiologic studies on patient outcome. Health-care funding is scarce, and therefore third-party payers and hospitals are demanding more efficiency and productivity from radiologic service providers. To meet these challenges, radiology departments could establish health outcomes and economics centers to study the clinical effectiveness of imaging and its impact on patient outcome. (orig.)

  15. FEMA Disaster Declarations Summary

    Data.gov (United States)

    Department of Homeland Security — The FEMA Disaster Declarations Summary is a summarized dataset describing all federally declared disasters, starting with the first disaster declaration in 1953,...

  16. Natural disasters and suicide: evidence from Japan.

    Science.gov (United States)

    Matsubayashi, Tetsuya; Sawada, Yasuyuki; Ueda, Michiko

    2013-04-01

    Previous research shows no consensus as to whether and how natural disasters affect suicide rates in their aftermath. Using prefecture-level panel data of natural disasters and suicide in Japan between 1982 and 2010, we estimate both contemporaneous and lagged effects of natural disasters on the suicide rates of various demographic groups. We find that when the damage caused by natural disasters is extremely large, as in the case of the Great Hanshin-Awaji Earthquake in 1995, suicide rates tend to increase in the immediate aftermath of the disaster and several years later. However, when the damage by natural disasters is less severe, suicide rates tend to decrease after the disasters, especially one or two years later. Thus, natural disasters affect the suicide rates of affected populations in a complicated way, depending on the severity of damages as well as on how many years have passed since the disaster. We also find that the effects of natural disasters on suicide rates vary considerably across demographic groups, which suggests that some population subgroups are more vulnerable to the impact of natural disasters than others. We then test the possibility that natural disasters enhance people's willingness to help others in society, an effect that may work as a protective factor against disaster victims' suicidal risks. We find that natural disasters increase the level of social ties in affected communities, which may mitigate some of the adverse consequence of natural disasters, resulting in a decline in suicide rates. Our findings also indicate that when natural disasters are highly destructive and disruptive, such protective features of social connectedness are unlikely to be enough to compensate for the severe negative impact of disasters on health outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Job autonomy, its predispositions and its relation to work outcomes in community health centers in Taiwan.

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Lin, Yung-Kai; Lin, Cheng-Chieh; Lin, Tien-Tse

    2013-06-01

    It has been debated that employees in a government or public ownership agency may perceive less need for growth opportunities or high-powered incentives than is the case for employees in private organizations. This study examined employees' job autonomy in government-run community health centers, its predispositions and its relation to their work outcomes. A cross-sectional study was conducted in Taiwan. From 230 responding community health centers, 1380 staff members responded to the self-completed, structured questionnaire. Structural equation modeling revealed that employees' job autonomy has positive work outcomes: greater work satisfaction, and less intent to transfer and intentions to leave. In addition, job autonomy was related to employees' higher education levels, medical profession, permanent employment and serving smaller populations. Moreover, employees' age, educational levels, medical profession and employment status were found to be related to their work satisfaction, intent to transfer and intent to leave.

  18. GENDER AND SHOPPING BEHAVIOR OUTCOMES IN THE CONTEXT OF SHOPPING CENTERS

    OpenAIRE

    Ioana Nicoleta ABRUDAN

    2016-01-01

    Understanding consumer behavior can be divided into three parts: before visiting the stores or shopping centers, during the visit, and after. From the point of view of the final result intended by retailers, satisfying customers in terms of profitability, all three components are equally important. A relevant segmentation criterion for most products and stores is gender. Previous research suggests that gender influences shopping motivations, the way people shop and shopping behavior outcomes....

  19. Disaster Management: Mental Health Perspective

    Science.gov (United States)

    Math, Suresh Bada; Nirmala, Maria Christine; Moirangthem, Sydney; Kumar, Naveen C.

    2015-01-01

    Disaster mental health is based on the principles of ‘preventive medicine’ This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six ‘R’s such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health. PMID:26664073

  20. Disaster Management: Mental Health Perspective.

    Science.gov (United States)

    Math, Suresh Bada; Nirmala, Maria Christine; Moirangthem, Sydney; Kumar, Naveen C

    2015-01-01

    Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.

  1. Maternal and neonatal outcomes at an alongside birth center and at a hospital.

    Science.gov (United States)

    Schneck, Camilla Alexsandra; Riesco, Maria Luiza Gonzalez; Bonadio, Isabel Cristina; Diniz, Carmem Simone Grilo; Oliveira, Sonia Maria Junqueira Vasconcellos de

    2012-02-01

    To compare maternal and neonatal outcomes in low-risk women assisited in an alongside birth center and at a hospital. A cross-sectional study was conducted with a representative sample of low-risk women in São Paulo (Southeastern Brazil), from 2003 to 2006. The study included 991 women who delivered a child at the alongside birth center and 325 who delivered a child at a hospital. Data were obtained from medical records. A comparative analysis was performed for all of the women, who were stratified according to parity. The chi-square test and Fisher's exact test were used to compare outcomes between women who delivered in alongside birth center and those who gave birth in the hospital. There was a homogeneous distribution of women according to parity (45.4% were nulliparous, and 54.6% had one or more previous deliveries). Statistically significant differences were found in the frequency of amniotomy (more frequent in nulliparous women treated at the hospital), the use of oxytocin during labor, and the use of postpartum analgesia (both more frequent among women of any parity treated at the hospital). The rate of episiotomy was higher in nulliparous women, both in the alongside birth center and at the hospital. Neonatal interventions were more frequent at the hospital and included aspiration of the upper airways, gastric aspiration, gastric lavage, and the use of an open oxygen mask. Other events that occurred with greater frequency at the hospital included caput succedaneum, respiratory discomfort, and admittance to the neonatal unit. There was no difference in Apgar scores at the fifth minute or cases of maternal or perinatal death. Care at the alongside birth center involved fewer interventions and had maternal and neonatal outcomes similar to those of the hospital setting.

  2. Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model.

    Science.gov (United States)

    Cykert, Samuel; Lefebvre, Ann; Bacon, Thomas; Newton, Warren

    The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services. Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina. The REC program provides onsite technical assistance to help small primary care practices achieve meaningful use of certified EHRs. While pursuing meaningful use functionality, practices were also offered complementary onsite advice regarding QI issues. We followed the first 50 primary care practices that utilized both EHR and QI advice targeting diabetes care. The achievement of meaningful use of certified EHRs and performance of QI with onsite practice facilitation showed an absolute improvement of 19% in the proportion of patients who achieved excellent diabetes control (hemoglobin A1c 9%) fell steeply in these practices. No control group was available for comparison. Practice facilitation that provided EHR and QI coaching support showed important improvements in diabetes outcomes in practices that achieved meaningful use of their EHR systems. This approach holds promise as a way to help small primary care practices achieve excellent patient outcomes. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  3. Engaging Stakeholders in Patient-Centered Outcomes Research Regarding School-Based Sealant Programs.

    Science.gov (United States)

    Chi, Donald L; Milgrom, Peter; Gillette, Jane

    2018-02-01

    Purpose: The purpose of this study was to use qualitative methods to describe the key lessons learned during the stakeholder engagement stage of planning a randomized clinical trial comparing outcomes of silver diamine fluoride (SDF) as an alternative to pit-and-fissure sealants in a school-based delivery system. Methods: Eighteen caregivers and community-based stakeholders with involvement in the school-based sealant program Sealants for Smiles from the state of Montana, were recruited for this qualitative study. United States (U.S.) Patient-Centered Outcomes Research Institute (PCORI) methodology standards were used to develop two semi-structured interview guides consisting of 6 questions. One interview guide was used for telephone interviews with caregivers and the second was used for a stakeholder focus group. Content analytic methods were used to analyze the data. Results: All participants believed that a study comparing SDF and sealants was clinically relevant. Non-caregiver stakeholders agreed with the proposed primary outcome of the study (caries prevention) whereas caregivers also emphasized the importance of child-centered outcomes such as minimizing dental anxiety associated with dental care. Stakeholders described potential concerns associated with SDF such as staining and perceptions of safety and discussed ways to address these concerns through community engagement, appropriate framing of the study, proper consent procedures, and ongoing safety monitoring during the trial. Finally, stakeholders suggested dissemination strategies such as direct communication of findings through professional organizations and encouraging insurance plans to incentivize SDF use by reimbursing dental providers. Conclusions: Involving key stakeholders in early planning is essential in developing patient-centered research questions, outcomes measures, study protocols, and dissemination plans for oral health research involving a school-based delivery system. Copyright © 2018

  4. Outcomes in Child Health: Exploring the Use of Social Media to Engage Parents in Patient-Centered Outcomes Research.

    Science.gov (United States)

    Dyson, Michele P; Shave, Kassi; Fernandes, Ricardo M; Scott, Shannon D; Hartling, Lisa

    2017-03-16

    With the rapid growth of technology and its improved accessibility globally, social media is gaining an increasingly important role in health care. Patients are frequently engaging with social media to access information, share content, and interact with others in online health communities. However, the use of social media as a stakeholder engagement strategy has been minimally explored, and effective methods for involving participants in research on the identification of patient-centered outcomes remain unknown. The aim of this study was to evaluate the process of using social media to engage parents in identifying patient-centered outcomes, using acute respiratory infections in children as an example to gauge feasibility. We conducted a process evaluation of a two-phase Web-based strategy to engage parents in research on patient-centered outcomes. In the first phase, we developed a website and study-specific Facebook and Twitter accounts to recruit parents to complete a Web-based survey identifying patient-centered outcomes. In the second phase, we used Facebook to host discussion with parents based on the survey results. The reach of social media as an engagement strategy and the characteristics of the population recruited were assessed. During the first phase, there were 5027 visits to the survey site, 110 participants completed the survey, 553 unique users visited the study website (675 visits), the Facebook page received 104 likes, and the Twitter account gained 52 followers over the 14-week study period. Most survey respondents identified Facebook (51.8%, 57/110) or a friend (45.5%, 50/110) as their source of referral. It was found that 70.0% (77/110) of respondents resided in Canada, in urban centers (92.7%, 102/110), and 88.2% (97/110) had a college or university degree or higher. The median year of birth was 1978 and 90.0% (99/110) were female. Most survey responses (88.2%, 97/110) were completed during the first month of the study. In the second phase, 4

  5. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    Directory of Open Access Journals (Sweden)

    Gilberto Campos Guimarães Filho

    2015-04-01

    Full Text Available Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective: Evaluate the control of blood pressure (BP and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results: We studied 1,298 individuals, predominantly women (60.9%, and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001 and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

  6. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    Energy Technology Data Exchange (ETDEWEB)

    Guimarães Filho, Gilberto Campos, E-mail: camposguimaraes@yahoo.com.br; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga [Liga de Hipertensão da Faculdade de Medicina da Universidade Federal de Goiânia, Goiás, GO (Brazil)

    2015-04-15

    Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

  7. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    International Nuclear Information System (INIS)

    Guimarães Filho, Gilberto Campos; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga

    2015-01-01

    Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased

  8. Diverticulitis Outcomes are Equivalent Between Level 1 Trauma Centers and Community Hospitals in New Jersey.

    Science.gov (United States)

    Gale, Stephen C; Arumugam, Dena; Dombrovskiy, Viktor Y

    2015-06-01

    Traditionally, general surgeons provide emergency general surgery (EGS) coverage by assigned call. The acute care surgery (ACS) model is new and remains confined mostly to academic centers. Some argue that in busy trauma centers, on-call trauma surgeons may be unable to also care for EGS patients. In New Jersey, all three Level 1 Trauma Centers (L1TC) have provided ACS services for many years. Analyzing NJ state inpatient data, we sought to determine whether outcomes in one common surgical illness, diverticulitis, have been different between L1TC and nontrauma centers (NTC) over a 10-year period. The NJ Medical Database was queried for patients aged 18 to 90 hospitalized from 2001 to 2010 for acute diverticulitis. Demographics, comorbidities, operative rates, and mortality were compiled and analyzed comparing L1TC to NTC. For additional comparison between L1TC and NTC, 1:1 propensity score matching with replacement was accomplished. χ(2), t test, and Cochran-Armitage trend test were used. From 2001 to 2010, 88794 patients were treated in NJ for diverticulitis. 2621 patients (2.95%) were treated at L1TCs. Operative rates were similar between hospital types. Patients treated at L1TCs were more often younger (63.1 ± 0.3 vs 64.7 ± 0.1; P diverticulitis are equivalent between LT1C and NTC in NJ. Trauma centers in NJ more commonly provide care to minority and uninsured patients.

  9. Birth outcomes for women using free-standing birth centers in South Auckland, New Zealand.

    Science.gov (United States)

    Bailey, David John

    2017-09-01

    This study investigates maternal and perinatal outcomes for women with low-risk pregnancies laboring in free-standing birth centers compared with laboring in a hospital maternity unit in a large New Zealand health district. The study used observational data from 47 381 births to women with low-risk pregnancies in South Auckland maternity facilities 2003-2010. Adjusted odds ratios with 95% confidence intervals were calculated for instrumental delivery, cesarean section, blood transfusion, neonatal unit admission, and perinatal mortality. Labor in birth centers was associated with significantly lower rates of instrumental delivery, cesarean section and blood transfusion compared with labor in hospital. Neonatal unit admission rates were lower for infants of nulliparous women laboring in birth centers. Intrapartum and neonatal mortality rates for birth centers were low and were not significantly different from the hospital population. Transfers to hospital for labor and postnatal complications occurred in 39% of nulliparous and 9% of multiparous labors. Risk factors identified for transfer were nulliparity, advanced maternal age, and prolonged pregnancy ≥41 weeks' gestation. Labor in South Auckland free-standing birth centers was associated with significantly lower maternal intervention and complication rates than labor in the hospital maternity unit and was not associated with increased perinatal morbidity. © 2017 Wiley Periodicals, Inc.

  10. Outcomes of American Lung Association-Indiana Lung Centers asthma program.

    Science.gov (United States)

    Summers, Kent H; Zillich, Alan J; Nyhuis, Allen W; Twigg, Homer L

    2005-10-01

    The American Lung Association of Indiana (ALA-I), in conjunction with participating Indiana hospitals, developed the Lung Center concept as a mechanism to provide standardized delivery of lung health education. The goal of this pilot study was to evaluate initial experience with the Lung Center program "Overcoming Your Asthma," a two-session asthma education program, and identify areas needing improvement. A total of 305 participants responded to a 31-item questionnaire at baseline (immediately prior to program exposure) and again at 1 month (n = 75) and 6 months (n = 30) after participation. Overall, delivery of the ALA-I Lung Center asthma education program improved respondents' experience with asthma. At one month after the educational session, the program improved participant knowledge about asthma. This was associated with modest improvements in treatment behaviors, economic outcomes and asthma symptoms such as reduced breathing difficulties, wheezing and asthma exacerbations, and improvement in sleep. Improvements were not uniformly sustained at 6 months. In summary, the Lung Center asthma education program appears to benefit patients with asthma. The results provide preliminary evidence to support continued delivery of asthma education in Lung Centers. Future efforts should emphasize education to improve treatment attitudes and behaviors.

  11. Approaches to Climate Change & Health in Cuba: Guillermo Mesa MD MPhil, Director, Disasters & Health, National School of Public Health. Paulo Ortiz MS PhD, Senior Researcher, Climate Center, Cuban Meteorology Institute.

    Science.gov (United States)

    Mesa, Guillermo; Ortiz, Paulo; Gorry, Conner

    2015-04-01

    The US National Institutes of Health predict climate change will cause an additional 250,000 deaths between 2030 and 2050, with damages to health costing US$2-$4 billion by 2030. Although much debate still surrounds climate change, island ecosystems-such as Cuba's-in the developing world are arguably among the most vulnerable contexts in which to confront climate variability. Beginning in the 1990s, Cuba launched research to develop the evidence base, set policy priorities, and design mitigation and adaptation actions specifically to address climate change and its effects on health. Two researchers at the forefront of this interdisciplinary, intersectoral effort are epidemiologist Dr Guillermo Mesa, who directed design and implementation of the nationwide strategy for disaster risk reduction in the Cuban public health system as founding director of the Latin American Center for Disaster Medicine (CLAMED) and now heads the Disasters and Health department at the National School of Public Health; and Dr Paulo Ortiz, a biostatistician and economist at the Cuban Meteorology Institute's Climate Center (CENCLIM), who leads the research on Cuba's Climate and Health project and is advisor on climate change and health for the UN Economic Commission for Latin America and the Caribbean (ECLAC).

  12. [Perspectives on researches in disaster psychiatry].

    Science.gov (United States)

    Tomita, Hiroaki

    2014-01-01

    After experiencing the catastrophic Great East Japan Earthquake and Tsunami disaster in 2011, Tohoku University founded the International Research Institute of Disaster Science (IRIDeS) in April, 2012. IRIDeS, comprising 7 divisions and 36 laboratories with broad areas of specialization, from the humanities to natural sciences, aims to become a global center for the study of disasters and disaster mitigation, learning from and building upon past lessons in disaster management from Japan and around the world. In IRIDeS, the Department of Disaster Psychiatry is in charge of dealing with issues related to disaster psychiatry, including the psychosocial impact of disasters. Now, at more than 2 and a half years after the catastrophic disaster, the psychological impact actually seems to be getting stronger and wider, whereas the memory of the disaster seems to be waning in other areas of the country. In such a situation, where a number of problems need to be resolved, what can/should we do as psychiatrists? On the other hand, other natural disasters, such as storms and floods, have kept hitting Japan, and catastrophes seem to strike somewhere in the world every year. In addition, we need to prepare for the possibility of a Nankai Trough Quake and an earthquake directly hitting the Tokyo area, which may occur sometime in the future. Considering the situation, we need to establish an education system for disaster psychiatry, and proceed with research to collect useful information to prepare for coming disasters. The aim of our department is to integrate multi-faceted basic and clinical research approaches to investigate the following topics: 1) to identify social, psychological, and biological factors involved in the pathophysiology of and recovery from disaster-related mental health problems; 2) to develop systems for disaster prevention, disaster response, and recovery, considering disaster-related psychiatric and psychological issues; 3) to develop useful tools for the

  13. Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

    Science.gov (United States)

    Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

    2014-10-01

    Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

  14. The development of a clinical outcomes survey research application: Assessment CenterSM

    Science.gov (United States)

    Rothrock, Nan E.; Hanrahan, Rachel T.; Jansky, Liz J.; Harniss, Mark; Riley, William

    2013-01-01

    Introduction The National Institutes of Health sponsored Patient-Reported Outcome Measurement Information System (PROMIS) aimed to create item banks and computerized adaptive tests (CATs) across multiple domains for individuals with a range of chronic diseases. Purpose Web-based software was created to enable a researcher to create study-specific Websites that could administer PROMIS CATs and other instruments to research participants or clinical samples. This paper outlines the process used to develop a user-friendly, free, Web-based resource (Assessment CenterSM) for storage, retrieval, organization, sharing, and administration of patient-reported outcomes (PRO) instruments. Methods Joint Application Design (JAD) sessions were conducted with representatives from numerous institutions in order to supply a general wish list of features. Use Cases were then written to ensure that end user expectations matched programmer specifications. Program development included daily programmer “scrum” sessions, weekly Usability Acceptability Testing (UAT) and continuous Quality Assurance (QA) activities pre- and post-release. Results Assessment Center includes features that promote instrument development including item histories, data management, and storage of statistical analysis results. Conclusions This case study of software development highlights the collection and incorporation of user input throughout the development process. Potential future applications of Assessment Center in clinical research are discussed. PMID:20306332

  15. The development of a clinical outcomes survey research application: Assessment Center.

    Science.gov (United States)

    Gershon, Richard; Rothrock, Nan E; Hanrahan, Rachel T; Jansky, Liz J; Harniss, Mark; Riley, William

    2010-06-01

    The National Institutes of Health sponsored Patient-Reported Outcome Measurement Information System (PROMIS) aimed to create item banks and computerized adaptive tests (CATs) across multiple domains for individuals with a range of chronic diseases. Web-based software was created to enable a researcher to create study-specific Websites that could administer PROMIS CATs and other instruments to research participants or clinical samples. This paper outlines the process used to develop a user-friendly, free, Web-based resource (Assessment Center) for storage, retrieval, organization, sharing, and administration of patient-reported outcomes (PRO) instruments. Joint Application Design (JAD) sessions were conducted with representatives from numerous institutions in order to supply a general wish list of features. Use Cases were then written to ensure that end user expectations matched programmer specifications. Program development included daily programmer "scrum" sessions, weekly Usability Acceptability Testing (UAT) and continuous Quality Assurance (QA) activities pre- and post-release. Assessment Center includes features that promote instrument development including item histories, data management, and storage of statistical analysis results. This case study of software development highlights the collection and incorporation of user input throughout the development process. Potential future applications of Assessment Center in clinical research are discussed.

  16. Maternal and Neonatal Outcomes of Women with Preeclampsia and Eclampsia at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Hediye Dağdeviren

    2015-12-01

    Full Text Available Aim: Preeclampsia is a multisystem disorder of unknown etiology and one of the leading causes of maternal, fetal and neonatal mortality and morbidity. Adverse outcomes can be improved by early identification of the disease and timely referral to a tertiary center. The aims of this study were to evaluate the outcomes of preeclampsia-eclampsia cases and share our experiences in a tertiary center. Methods: The study conducted by retrospectively analyzing the data of 350 women who gave birth between 2008 and 2013 at a tertiary care center. Results: The mean age of the enrolled women was 35 years, the mean gestational age at delivery-36 weeks, the mean birth weight-2.73 kg, and the mean platelet count was 204.000/ mm3. The incidence of preterm deliveries was 66.6%. Severe preeclampsia was noted in 29.4% of cases. Neonatal intensive care unit admissions were seen in 10.6% of cases. A total of 22.9% of these women had vaginal deliveries, while the other 77.1% underwent cesarean section. High systolic blood pressure and elevated serum alanine and aspartate aminotransferase values had significant independent effects of differentiating between mild and severe preeclampsia. Conclusion: Fetomaternal morbidity and mortality rates associated with hypertensive disorders are alarming, especially in developing countries. As such, the high-risk obstetric population should be screened earlier in pregnancy. A system allowing early referral in these cases should be created. (The Medical Bulletin of Haseki 2015; 53:143-6

  17. Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process.

    Science.gov (United States)

    Shafi, Shahid; Friese, Randall; Gentilello, Larry M

    2008-02-01

    Similarly designated trauma centers do not achieve similar outcomes. Outcomes study. Academic research. Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified. Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of /=90 mm Hg [n = 184 650]), moderate (ISS of >/=25 with SBP of >/=90 mm Hg or ISS of /=25 with SBP of mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals. When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.

  18. First response, rehabilitation, and outcomes of hand and upper limb function: survivors of the bali bombing disaster. A case series report.

    Science.gov (United States)

    Edgar, Dale Wesley; Wood, F; Goodwin-Walters, A

    2006-01-01

    In October 2002, two bombs exploded in Bali injuring hundreds, and killing 202 people. The purpose of this paper is to report the organization of the first response, rehabilitation strategies, and outcome of a series of patients evacuated to the Royal Perth Hospital (RPH), a civilian hospital in Australia. The initial medical response in Bali was primarily conducted by holidaying health professionals supporting the hospital on the island. The Australian Defence Force was primarily responsible for the ongoing acute clinical management during the evacuation and repatriation of survivors to all major burn units in Australia. At the RPH, hospital adaptations included novel staffing and treatment strategies to sustain a team effort beyond the acute phase of the disaster to manage the surge of 28 patients (15% of yearly admissions) in 7 days. Data collected were related to service delivery and patient outcomes (shoulder active range of motion, grip strength, and the Burns Specific Health Scale). Data were compared to baseline, similar data collected during normal practice and population norms. Bali patients received 3.2% more therapy treatment sessions and 6.8% less contact hours than usual protocols. Shoulder AROM recovered to normal limits by 3 months postdischarge. Grip strength for women was shown to reach population norms by 1 month after discharge and by 6 months for males. Self-rated physical recovery exceeded major burn population norms at 6 months postdischarge. Physical therapy outcome measures demonstrated upper limb recovery as usual in the Bali group, despite a mass casualty situation. To achieve this required support from the multidisciplinary team, in combination with community, government, and hospital administrative assistance.

  19. For establishment on nuclear disaster prevention system

    International Nuclear Information System (INIS)

    Anon.

    2000-01-01

    For increasing requirement of peoples for review of nuclear disaster countermeasure at a chance of the JCO critical accident, the Japanese Government newly established the 'Special Measure Act on Nuclear Disaster Countermeasure', which was enacted on July 16, 2000. The nuclear business relatives such as electric power company and so forth established the Business program on nuclear disaster prevention in nuclear business relatives' after their consultation with local communities at their construction, under their co-operation. Simultaneously, the electric power industry field decided to intend to provide some sufficient countermeasures to incidental formation of nuclear accident such as start of the Co-operative agreement on nuclear disaster prevention among the nuclear business relatives' and so forth. Here were described on nuclear safety and disaster prevention, nuclear disaster prevention systems at the electric power industry field, abstract on 'Business program on nuclear disaster prevention in nuclear business relatives', preparation of technical assistance system for nuclear disaster prevention, executive methods and subjects on nuclear disaster prevention at construction areas, recent business on nuclear disaster prevention at the Nuclear Technical Center, and subjects on establishment of nuclear disaster prevention system. (G.K.)

  20. Outcome study of brief relational-cultural therapy in a women's mental health center.

    Science.gov (United States)

    Oakley, M Anne; Addison, Shirley C; Piran, Niva; Johnston, Gary J; Damianakis, Mary; Curry, Joyce; Dunbar, Christine; Weigeldt, Almuth

    2013-01-01

    The current study is the first to evaluate the effectiveness of a brief relational-cultural model of therapy in a community-based mental health center for women. The study was distinctive in its use of a hybrid model that employed elements of randomized control and naturalistic design. Results showed that the entire treatment group of 91 women improved significantly on all eight outcome measures. Therapeutic gains were maintained at 3- and 6-month follow-ups. The results lend support to the importance of including relational-cultural factors in the treatment of women. An adherence scale/manual was developed and implemented and will allow for replication.

  1. Outcomes of Kidney Transplantation Abroad: A Single-Center Canadian Cohort Study.

    Science.gov (United States)

    Quach, Kevin; Sultan, Heebah; Li, Yanhong; Famure, Olusegun; Kim, S Joseph

    2016-03-01

    An increasing demand for kidney transplantation has enticed some patients with end-stage renal disease (ESRD) to venture outside their country of residence, but their posttransplant outcomes may be suboptimal. We compared the risks and clinical outcomes among tourists, or patients who pursue a kidney transplant abroad, versus patients who received a transplant at the Toronto General Hospital (TGH). A single-center, 1:3 matched (based on age at transplant, time on dialysis, and year of transplant) cohort study was conducted. Forty-five tourists were matched with 135 domestic transplant recipients between January 1, 2000, and December 31, 2011. Multivariable Cox proportional hazards models were fitted to assess graft and patient outcomes. Among the 45 tourists, the majority (38 of 45) traveled to the Middle East or Far East Asia, and most received living donor kidney transplants (35 of 45). Multivariable Cox proportional hazards models showed that tourists had a higher risk for the composite outcome of acute rejection, death-censored graft failure, or death with graft function (DWGF; hazard ratio [HR] 2.08, 95% confidence interval [CI]: 1.06-4.07). Tourists also showed a higher risk for the individual end points of acute rejection, DWGF, and posttransplant hospitalizations. Patients going abroad for kidney transplantation may have inferior outcomes compared to domestic patients receiving kidney transplants. Patients who are contemplating an overseas transplant need to be aware of the increased risk of adverse posttransplant outcomes and should be appropriately counseled by transplant professionals during the pretransplant evaluation process. © 2016, NATCO.

  2. Yoga Therapy Research: A Whole-Systems Perspective on Comparative Effectiveness and Patient-Centered Outcomes.

    Science.gov (United States)

    Rioux, Jennifer G

    2015-01-01

    For the yoga research community to capitalize on its current momentum, it is critical to consider certain developments in research theory and innovative methodologies. The concept of model validity must be incorporated in yoga therapy research so that explanatory constructs employed and outcome measures chosen reflect the principles of traditional yogic science. Focusing on effectiveness research will ensure maximum generalizability of study results and reflect real-world therapy delivery settings, thereby increasing the relevance of outcomes. Whole systems of healing require research methodologies that address complex relationships between multi-target therapies with multiple potential treatment results. Complex, dynamic systems theory provides the theoretical and methodological innovations necessary to design studies, choose outcomes, and analyze data in a way that can account for charting complex, cyclical, therapeutic trajectories across time. Emphasizing patient-centered outcomes is aligned with the patent-oriented and tailored natured of yoga therapy delivery. Increasing the quality and quantity of comparative effectiveness research to analyze the harms and benefits of contrasting therapies can provide an infrastructure for designing studies that can have significant practical impact. The creation of practice-based research networks within the yoga research community will incentivize links between mainstream clinical researchers and yoga therapy delivery settings, ultimately developing collaborative networks. Yoga therapy centers can facilitate patient recruitment for studies and inform standards for yoga researchers. Collaborative efforts between the yoga and ayurvedic research communities will streamline efforts, solidify expertise, cross-pollinate theoretical and methodological innovation, and consolidate efforts to secure research funding and increase publication and dissemination of study findings.

  3. Conduct of Occupational Health During Major Disasters: A Comparison of Literature on Occupational Health Issues in the World Trade Center Terrorist Attack and the Fukushima Nuclear Power Plant Accident.

    Science.gov (United States)

    Toyoda, Hiroyuki; Mori, Koji

    2017-01-01

    Workers who respond to large-scale disasters can be exposed to health hazards that do not exist in routine work. It is assumed that learning from past cases is effective for preparing for and responding to such problems, but published information is still insufficient. Accordingly, we conducted a literature review about the health issues and occupational health activities at the World Trade Center (WTC) terrorist attack and at the Fukushima Nuclear Power Plant accident to investigate how occupational health activities during disasters should be conducted. Seven studies about the WTC attack were extracted and categorized into the following topics: "in relation to emergency systems including occupational health management"; "in relation to improvement and prevention of health effects and occupational hygiene"; and "in relation to care systems aimed at mitigating health effects." Studies about the Fukushima Nuclear Power Plant accident have been used in a previous review. We conclude that, to prevent health effects in workers who respond to large-scale disasters, it is necessary to incorporate occupational health regulations into the national response plan, and to develop practical support functions that enable support to continue for an extended period, training systems for workers with opportunities to report accidents, and care systems to mitigate the health effects.

  4. Treatment outcomes in stage IIIA non-small-cell lung cancer in a community cancer center.

    Science.gov (United States)

    Hanson, Shaun; Persad, Kamleish; Qiao, Xian; Guarino, Michael; Petrelli, Nicholas

    2015-08-01

    Treatment outcomes for non-small-cell lung cancer (NSCLC) patients diagnosed at stage IIIA have been analyzed in many studies, which generally involve patients younger and healthier than the average patient with this disease. To analyze demographics and treatment outcomes in patients with stage IIIA NSCLC at a community cancer center. We reviewed charts of 226 patients diagnosed with stage IIIA NSCLC from January 2003 to December 2008 treated at our community cancer center. Results Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively. Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively. Study design was retrospective and some medical records were not available. However, this population is likely representative of patients treated in similar settings. In our population, advanced age and male gender were associated with lower median survival. Responses to concurrent and sequential chemoradiation seemed to differ based on age group, which may be useful as a prognostic guideline for similar populations. ©2015 Frontline Medical Communications.

  5. Clinical presentation, management, and postnatal outcomes of fetal tachyarrhythmias: A 10-year single-center experience

    Science.gov (United States)

    Karmegeraj, Balaganesh; Namdeo, Sushmita; Sudhakar, Abish; Krishnan, Vivek; Kunjukutty, Radhamany; Vaidyanathan, Balu

    2018-01-01

    Background: Limited information is available regarding the prevalence and outcomes of fetal tachyarrhythmias from the developing countries. Aims: This study aims to report referral patterns, management protocols, and pregnancy outcomes of fetuses with tachyarrhythmias reporting to a single center in South India. Methods: All fetuses with documented sustained fetal tachyarrhythmia during the study period (2008–2017) were included. Arrhythmia characterization and hemodynamic evaluation were done using fetal echocardiography. Patients were grouped into supraventricular tachycardia (SVT) and atrial flutter (AF) groups. Patient characteristics, transplacental therapy (TPT), pregnancy, and postnatal outcomes were analyzed. Results: Total of 19 fetuses included; 11 had SVT and 8 AF. Mean gestational age at referral was higher for AF (32.5 ± 3.2 vs. 29.6 ± 3.3 weeks; P = 0.05). Hydrops fetalis was present 8 (42%) fetuses; 4 in each group. TPT was instituted in 18 fetuses; 12 (66.7%) received combination therapy; 4 (21%) received direct fetal therapy. Eighteen fetuses (91%) were born alive with one intrauterine death in a fetus with SVT and severe hydrops. Seven (87.5%) fetuses with hydrops survived. Twelve patients (66.7%) were delivered in sinus rhythm. Six babies (33.3%) had tachycardia at birth requiring anti-arrhythmic therapy. All patients survived the neonatal period. Duration of trans-placental therapy (3.8 + 3.3 vs. 7.3 + 3.4 weeks) was shorter in the AF group. Conclusions: Aggressive TPT using combination of drugs achieves excellent pregnancy and postnatal outcomes in fetuses with tachyarrhythmia. Early diagnosis and prompt referral before hemodynamic decompensation is critical for ensuring optimal outcomes. PMID:29440828

  6. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers.

    Science.gov (United States)

    Villamere, James; Gebhart, Alana; Vu, Stephen; Nguyen, Ninh T

    2015-07-01

    Robotic-assisted general and bariatric surgery is gaining popularity among surgeons. The aim of this study was to analyze the utilization and outcome of laparoscopic versus robotic-assisted laparoscopic techniques for common elective general and bariatric surgical procedures performed at Academic Medical Centers. We analyzed data from University HealthSystem Consortium clinical database from October 2010 to February 2014 for all patients who underwent laparoscopic versus robotic techniques for eight common elective general and bariatric surgical procedures: gastric bypass, sleeve gastrectomy, gastric band, antireflux surgery, Heller myotomy (HM), cholecystectomy (LC), colectomy, rectal resection (RR). Utilization and outcome measures including demographics, in-hospital mortality, major complications, 30-day readmission, length of stay (LOS), and costs were compared between techniques. 96,694 laparoscopic and robotic procedures were analyzed. Utilization of the robotic approach was the highest for RR (21.4%), followed by HM (9.1%). There was no significant difference in in-hospital mortality or major complications between laparoscopic versus robotic techniques for all procedures. Only two procedures had improved outcome associated with the robotic approach: robotic HM and robotic LC had a shorter LOS compared to the laparoscopic approach (2.8 ± 3.6 vs. 2.3 ± 2.1; respectively, p bariatric surgical procedures with the highest utilization for rectal resection. Compared to conventional laparoscopy, there were no observed clinical benefits associated with the robotic approach, but there was a consistently higher cost.

  7. Promising Outcomes in Teen Mothers Enrolled in a School-Based Parent Support Program and Child Care Center

    Science.gov (United States)

    Sadler, Lois S.; Swartz, Martha K.; Ryan-Krause, Patricia; Seitz, Victoria; Meadows-Oliver, Mikki; Grey, Margaret; Clemmens, Donna A.

    2007-01-01

    Background: This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. Methods: A volunteer sample of 65 adolescent…

  8. Disaster Risk Management: Urban Flooding and heatstress

    NARCIS (Netherlands)

    Verlaat, Mark; Boogaard, Floris; Kluck, Jeroen; van der Meulen, Leon; Schoof, Govert; Brovelli, Maria Antonia; Minghini, Marco; Negretti, Marco

    2015-01-01

    Natural disasters are a growing concern around the globe. In the Netherlands, water has always played an important role as both friend and enemy. To quickly analyze and visualise possible disaster outcomes has been really difficult. In collaboration with engineering company Tauw we improved this

  9. Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

    Science.gov (United States)

    Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P

    2017-01-01

    There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

  10. Disaster Risk Education of Final Year High School Students Requires a Partnership with Families and Charity Organizations: An International Cross-sectional Survey.

    Science.gov (United States)

    Codreanu, Tudor A; Celenza, Antonio; Ngo, Hanh

    2016-06-01

    Introduction The aim of disaster reduction education (DRE) is to achieve behavioral change. Over the past two decades, many efforts have been directed towards this goal, but educational activities have been developed based on unverified assumptions. Further, the literature has not identified any significant change towards disaster preparedness at the individual level. In addition, previous research suggests that change is dependent on multiple independent predictors. It is difficult to determine what specific actions DRE might result in; therefore, the preamble of such an action, which is to have discussions about it, has been chosen as the surrogate outcome measure for DRE success. This study describes the relationship of the perceived entity responsible for disaster education, disaster education per se, sex, and country-specific characteristics, with students discussing disasters with friends and family as a measure of proactive behavioral change in disaster preparedness. A total of 3,829 final year high school students participated in an international, multi-center prospective, cross-sectional study using a validated questionnaire. Nine countries with different levels of disaster exposure risk and economic development were surveyed. Regression analyses examined the relationship between the likelihood of discussing disasters with friends and family (dependent variable) and a series of independent variables. There was no statistically significant relationship between a single entity responsible for disaster education and discussions about potential hazards and risks with friends and/or family. While several independent predictors showed a significant main effect, DRE through school lessons in interaction with Family & Charity Organizations had the highest predictive value. Disaster reduction education might require different delivery channels and methods and should engage with the entities with which the teenagers are more likely to collaborate. Codreanu TA

  11. Improved Outcomes for Hispanic Women with Gestational Diabetes Using the Centering Pregnancy© Group Prenatal Care Model.

    Science.gov (United States)

    Schellinger, Megan M; Abernathy, Mary Pell; Amerman, Barbara; May, Carissa; Foxlow, Leslie A; Carter, Amy L; Barbour, Kelli; Luebbehusen, Erin; Ayo, Katherine; Bastawros, Dina; Rose, Rebecca S; Haas, David M

    2017-02-01

    Objective To determine the impact of Centering Pregnancy © -based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy © prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy © group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy © prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy © group prenatal care may have improved outcomes.

  12. Clinical outcome of 36 male patients with primary urethral carcinoma. A single center experience

    International Nuclear Information System (INIS)

    Thyavihally, Y.B.; Tongaonkar, H.B.; Srivastava, S.K.; Mahantshetty, U.; Kumar, P.; Raibhattanavar, S.G.

    2006-01-01

    The aim of this study was retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor. A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed. The overall median survival time was 55.16 months. The 5-year overall and disease-free survival rate for the cohort was 49% and 23%, respectively. The 5-year survival is 67% for low-stage versus 33% for high-stage tumors and is significantly different (P=0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P-value of 0.02. The tumor location and clinicopathological stage were the most important predictors of the disease-free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors. (author)

  13. A new taxonomy for stakeholder engagement in patient-centered outcomes research.

    Science.gov (United States)

    Concannon, Thomas W; Meissner, Paul; Grunbaum, Jo Anne; McElwee, Newell; Guise, Jeanne-Marie; Santa, John; Conway, Patrick H; Daudelin, Denise; Morrato, Elaine H; Leslie, Laurel K

    2012-08-01

    Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.

  14. Stakeholder engagement in patient-centered outcomes research: high-touch or high-tech?

    Science.gov (United States)

    Lavallee, Danielle C; Wicks, Paul; Alfonso Cristancho, Rafael; Mullins, C Daniel

    2014-06-01

    Patient and stakeholder engagement enhances the meaningfulness of patient-centered outcomes research. Continuous engagement of diverse patients helps to achieve representativeness and to avoid tokenism, but is perceived as challenging due to resource and time constraints. The widespread availability of the internet, mobile phones, and electronic devices makes 'high-tech' solutions appealing, but such approaches may trade-off larger sample sizes for shallower engagement and/or skewed perspectives if most participants reflect users of technology. More traditional 'high-touch' solutions such as in-person interviews, focus groups, and town hall meetings can provide qualitative and sociological context and potentially more in-depth insights from small numbers of patients, but such approaches are also prone to selection bias as well. We compare and contrast high-tech and high-touch approaches to engaging stakeholders and suggest hybrid processes.

  15. Stroke quality metrics: systematic reviews of the relationships to patient-centered outcomes and impact of public reporting.

    Science.gov (United States)

    Parker, Carol; Schwamm, Lee H; Fonarow, Gregg C; Smith, Eric E; Reeves, Mathew J

    2012-01-01

    Stroke quality metrics play an increasingly important role in quality improvement and policies related to provider reimbursement, accreditation, and public reporting. We conducted 2 systematic reviews examining the relationships between compliance with stroke quality metrics and patient-centered outcomes, and public reporting of stroke metrics and quality improvement, quality of care, or outcomes. MEDLINE and EMBASE databases were searched to identify studies that evaluated the relationship between stroke quality metric compliance and patient-centered outcomes in acute hospital settings and public reporting of stroke quality metrics and quality improvement activities, quality of care, or patient outcomes. We specifically excluded studies that evaluated the effect of stroke units or hospital certification. Fourteen studies met eligibility criteria for the review of stroke quality metric compliance and patient-centered outcomes; 9 found mostly positive associations, whereas 5 found no or very limited associations. Only 2 eligible studies were found that directly addressed the public reporting of stroke quality metrics. Some studies have found positive associations between stroke metric compliance and improved patient-centered outcomes. However, high-quality studies are lacking and several methodological difficulties make the interpretation of the reported associations challenging. Information on the impact of public reporting of stroke quality metric data is extremely limited. Legitimate questions remain as to whether public reporting of stroke metrics is accurate, effective, or has the potential for unintended consequences. The generation of high-quality data examining quality metrics and stroke outcomes as well as the impact of public reporting should be given priority.

  16. Interdisciplinary Environmental-health Science Throughout Disaster Lifecycles

    Science.gov (United States)

    Plumlee, G. S.; Morman, S. A.; Hoefen, T. M.

    2014-12-01

    Potential human health effects from exposures to hazardous disaster materials and environmental contamination are common concerns following disasters. Using several examples from US Geological Survey environmental disaster responses (e.g., 2001 World Trade Center, mine tailings spills, 2005 Hurricane Katrina, 2007-2013 wildfires, 2011 Gulf oil spill, 2012 Hurricane Sandy, 2013 Colorado floods) and disaster scenarios (2011 ARkStorm, 2013 SAFRR tsunami) this presentation will illustrate the role for collaborative earth, environmental, and health science throughout disaster lifecycles. Pre-disaster environmental baseline measurements are needed to help understand environmental influences on pre-disaster health baselines, and to constrain the magnitude of a disaster's impacts. During and following disasters, there is a need for interdisciplinary rapid-response and longer-term assessments that: sample and characterize the physical, chemical, and microbial makeup of complex materials generated by the disasters; fingerprint material sources; monitor, map, and model dispersal and evolution of disaster materials in the environment; help understand how the materials are modified by environmental processes; and, identify key characteristics and processes that influence the exposures and toxicity of disaster materials to humans and the living environment. This information helps emergency responders, public health experts, and cleanup managers: 1) identify short- and long-term exposures to disaster materials that may affect health; 2) prioritize areas for cleanup; and 3) develop appropriate disposal solutions or restoration uses for disaster materials. By integrating lessons learned from past disasters with geospatial information on vulnerable sources of natural or anthropogenic contaminants, the environmental health implications of looming disasters or disaster scenarios can be better anticipated, which helps enhance preparedness and resilience. Understanding economic costs of

  17. Prognostic Factors and Treatment Outcomes of Parotid Gland Cancer: A 10-Year Single-Center Experience.

    Science.gov (United States)

    Chang, Jae Won; Hong, Hyun Jun; Ban, Myung Jin; Shin, Yoo Seob; Kim, Won Shik; Koh, Yoon Woo; Choi, Eun Chang

    2015-12-01

    To investigate the treatment outcomes of parotid gland cancer at a single center over a 10-year period and to evaluate the prognostic significance of maximum standardized uptake value. Retrospective case series with chart review. Academic care center. Ninety-eight patients with primary parotid gland cancer who were surgically treated at Yonsei University Head & Neck Cancer Clinic between January 1999 and December 2008 were analyzed. Patient data were collected retrospectively from medical charts. The investigators analyzed the association of clinicopathological factors and maximum standardized uptake value on (18)F-fluorodeoxyglucose positron emission tomography-computed tomography scan with disease-specific survival. Mean patient age was 49.7 years. Mean follow-up was 48.8 months. Thirty-three, 40, 30, and 23 patients had stage I, II, III, and IVA disease, respectively. Mucoepidermoid carcinoma was the most common histologic type (34.7%), followed by acinic cell carcinoma (27.6%). Eighteen patients (18.4%) experienced recurrences (mean recurrence gap, 20.6 months; range, 2-87 months). Five- and 10-year disease-specific survival rates were 93.6% and 81.8%, respectively. In the univariate analysis, pathologic T stage, pathologic lymph node status, resection margin, external parenchymal extension, and maximum standardized uptake value were significantly associated with disease-specific survival. Pathologic lymph node status and maximum standardized uptake value were independent prognostic factors in the multivariate analysis. Our single-center experience with parotid gland cancer treatment is consistent with the literature. Cervical lymph node metastasis and high maximum standardized uptake value are associated with poor survival in parotid gland cancer. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  18. The effect of playing a science center-based mobile game: Affective outcomes and gender differences

    Science.gov (United States)

    Atwood-Blaine, Dana

    Situated in a hands-on science center, The Great STEM Caper was a collaborative mobile game built on the ARIS platform that was designed to engage 5th-9th grade players in NGSS science and engineering practices while they interacted with various exhibits. Same gender partners sharing one iPad would search for QR codes placed at specific exhibits; scanning a code within the game would launch a challenge for that exhibit. The primary hypothesis was that in- game victories would be equivalent to "mastery experiences" as described by Bandura (1997) and would result in increased science self-efficacy. Gender differences in gameplay behaviors and perceptions were also studied. The study included two groups, one that played the game during their visit and one that explored the science center in the traditional way. The Motivation to Learn Science Questionnaire was administered to participants in both groups both before and after their visit to the science center. Participants wore head-mounted GoPro cameras to record their interactions within the physical and social environment. No differences in affective outcomes were found between the game and comparison groups or between boys and girls in the game group. The MLSQ was unable to measure any significant change in science self-efficacy, interest and enjoyment of science, or overall motivation to learn science in either group. However, girls outperformed boys on every measure of game achievement. Lazzaro's (2004) four types of fun were found to be a good fit for describing the gender differences in game perceptions and behaviors. Girls tended to enjoy hard fun and collaborative people fun while boys enjoyed easy fun and competitive people fun. While boys associated game achievement with enjoyment and victory, girls perceived their game achievement as difficult, rather than enjoyable or victorious.

  19. [Outcome of triplet pregnancies managed for twin-to-twin transfusion syndrome: A single center experience].

    Science.gov (United States)

    Chalouhi, G E; Quibel, T; Benzina, N; Bernard, J-P; Essaoui, M; Ville, Y

    2016-10-01

    Study the outcomes of triplet pregnancies (GGG) complicated with twin-to-twin transfusion syndrome (TTTS) treated with laser fetoscopy. Retrospective study of interventions, outcomes and perinatal follow-up of GGG treated for TTS. Between 2002 and 2013, 25 GGG complicated by TTTS were seen in our center, 20 dichorionic and 5 monochorionic. The mean gestational age (GA) at diagnosis of TTTS was 19.7 GW (±2.4) with 2, 4, 16 and 1 pregnancies at Quintero's stage I, II, III and V, respectively. They had a fetoscopy at an average GA of 19 GW and 6 days. There were 3 (13.0%) late miscarriages. The average GA at delivery was of 29.6 GW overall (26.3 GW and 31.1 GW in monochorionic and dichorionic pregnancies respectively). The overall fetal survival rate was 57.97% (40% and 66.7% in the group of monochorionic dichorionic pregnancies, respectively). However, neonatal mortality (<28 days) is 17.5%. GGG operated by fetoscopy for TTTS have a survival rate of three, at least 2 and at least 1 fetus of 21.7%, 69.6% and 82.6% respectively. The overall fetal survival rate is 59.97%. There is a tendency for better survival rates in dichorionic GGG compared to monochorionic GGG (P=0.079). Copyright © 2016. Published by Elsevier Masson SAS.

  20. Outcomes of Older Adults with Burn Injury: University Clinical Center of Kosovo.

    Science.gov (United States)

    B Duci, Shkelzen; M Arifi, Hysni; R Ahmeti, Hasan; K Zatriqi, Violeta; A Buja, Zejn; T Hoxha, Enver; Y Mekaj, Agon

    2015-07-01

    Advances in burn care over the past 50 years have brought about remarkable improvement in mortality rates such that survival has become an expected outcome even in patients with extensive injuries. Although these improvements have occurred in all age groups, survival in older adults still lags far behind that in younger cohorts. This study determines the outcomes of older adults with burn injury in University Clinical Center of Kosovo. This is a retrospective study that includes 56 burn patients, older than 60 years who were admitted at the Department of Plastic Surgery, between 1 January 2004 and 31 December 2013. Data processing was done with the statistical package of Stat 3. From the statistical parameters the structural index, arithmetic median, and standard deviation were calculated. Fifty six burned patient older than 60 years were included during a 10-year period. Of the 56 elderly patients 29 were women and 27 were men with a mean age of 66.7 years (range, 60-85 years). The differences were not statistically significant for both genders regarding the causes of burn injury. Considering the gradual increase of the elderly population in our country based on the data of the Ministry of Public Services, an increase is expected to the incidence of burn injuries in the population of this category of our country.

  1. Upper Airway Stimulation for OSA: Early Adherence and Outcome Results of One Center.

    Science.gov (United States)

    Kent, David T; Lee, Jake J; Strollo, Patrick J; Soose, Ryan J

    2016-07-01

    To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA). Case series with chart review. Academic sleep medicine center. The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system. Data included demographics, body mass index (BMI), apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), nightly hours of device usage, and procedure- and therapy-related complications. Mean age was 64.8 ± 12.0 years, with 50% female. Mean BMI was unchanged postoperatively (26.5 ± 4.2 to 26.8 ± 4.5 kg/m(2); P > .05). Mean AHI (33.3 ± 13.0 to 5.1 ± 4.3; P stimulation amplitude was 1.89 ± 0.50 V after titration. Adherence monitoring via device interrogation showed high rates of voluntary device use (mean 7.0 ± 2.2 h/night). For a clinical and anatomical subset of patients with OSA, HNS therapy is associated with good objective adherence, low morbidity, and improved OSA outcome measures. Early results at one institution suggest that HNS therapy can be implemented successfully into routine clinical practice, outside of a trial setting. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  2. Indications and outcomes of pediatric keratoplasty in a tertiary eye care center: A retrospective review.

    Science.gov (United States)

    Gulias-Cañizo, Rosario; Gonzalez-Salinas, Roberto; Hernandez-Zimbron, Luis Fernando; Hernandez-Quintela, Everardo; Sanchez-Huerta, Valeria

    2017-11-01

    To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.

  3. Outcomes from patients with presumed drug resistant tuberculosis in five reference centers in Brazil.

    Science.gov (United States)

    Ramalho, D M P; Miranda, P F C; Andrade, M K; Brígido, T; Dalcolmo, M P; Mesquita, E; Dias, C F; Gambirasio, A N; Ueleres Braga, J; Detjen, A; Phillips, P P J; Langley, I; Fujiwara, P I; Squire, S B; Oliveira, M M; Kritski, A L

    2017-08-15

    The implementation of rapid drug susceptibility testing (DST) is a current global priority for TB control. However, data are scarce on patient-relevant outcomes for presumptive diagnosis of drug-resistant tuberculosis (pDR-TB) evaluated under field conditions in high burden countries. Observational study of pDR-TB patients referred by primary and secondary health units. TB reference centers addressing DR-TB in five cities in Brazil. Patients age 18 years and older were eligible if pDR-TB, culture positive results for Mycobacterium tuberculosis and, if no prior DST results from another laboratory were used by a physician to start anti-TB treatment. The outcome measures were median time from triage to initiating appropriate anti-TB treatment, empirical treatment and, the treatment outcomes. Between February,16th, 2011 and February, 15th, 2012, among 175 pDR TB cases, 110 (63.0%) confirmed TB cases with DST results were enrolled. Among study participants, 72 (65.5%) were male and 62 (56.4%) aged 26 to 45 years. At triage, empirical treatment was given to 106 (96.0%) subjects. Among those, 85 were treated with first line drugs and 21 with second line. Median time for DST results was 69.5 [interquartile - IQR: 35.7-111.0] days and, for initiating appropriate anti-TB treatment, the median time was 1.0 (IQR: 0-41.2) days. Among 95 patients that were followed-up during the first 6 month period, 24 (25.3%; IC: 17.5%-34.9%) changed or initiated the treatment after DST results: 16/29 MDRTB, 5/21 DR-TB and 3/45 DS-TB cases. Comparing the treatment outcome to DS-TB cases, MDRTB had higher proportions changing or initiating treatment after DST results (p = 0.01) and favorable outcomes (p = 0.07). This study shows a high rate of empirical treatment and long delay for DST results. Strategies to speed up the detection and early treatment of drug resistant TB should be prioritized.

  4. Improving outcomes at Level I trauma centers: an early evaluation of the Trauma Survivors Network.

    Science.gov (United States)

    Castillo, Renan C; Wegener, Stephen T; Newell, Mary Zadnik; Carlini, Anthony R; Bradford, Anna N; Heins, Sara E; Wysocki, Elizabeth; Pollak, Andrew N; Teter, Harry; Mackenzie, Ellen J

    2013-06-01

    The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6 months. Outcomes evaluated at 6 months included depression, anxiety, self-efficacy, health status, and patient activation. Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression (p = 0.05). The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. Therapeutic study, level IV.

  5. Clinical profile and outcome of renal tubular disorders in children: A single center experience

    Directory of Open Access Journals (Sweden)

    B Vijay Kiran

    2014-01-01

    Full Text Available Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA (44%, Bartter-like (Bartter′s and Gitelman syndromes (22% followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome (13% and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11 years. Growth failure was the presenting feature in 86% of children followed by polyuria (60% and bone deformities (47%. In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well.

  6. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  7. Radiation accident/disaster

    International Nuclear Information System (INIS)

    Kida, Yoshiko; Hirohashi, Nobuyuki; Tanigawa, Koichi

    2013-01-01

    Described are the course of medical measures following Fukushima Daiichi Nuclear Power Plant (FNPP) Accident after the quake and tsunami (Mar. 11, 2011) and the future task for radiation accident/disaster. By the first hydrogen explosion in FNPP (Mar. 12), evacuation of residents within 20 km zone was instructed, and the primary base for measures of nuclear disaster (Off-site Center) 5 km afar from FNPP had to work as a front base because of damage of communicating ways, of saving of injured persons and of elevation of dose. On Mar. 13, the medical arrangement council consisting from stuff of Fukushima Medical University (FMU), National Institute of Radiological Sciences, Nuclear Safety Research Association and Prefectural officers was setup in residents' hall of Fukushima City, and worked for correspondence to persons injured or exposed, where communication about radiation and between related organizations was still poor. The Off-site Center's head section moved to Prefectural Office on Mar. 15 as headquarters. Early in the period, all residents evacuated from the 20 km zone, and in-hospital patients and nursed elderly were transported with vehicles, >50 persons of whom reportedly died mainly by their base diseases. The nation system of medicare for emergent exposure had consisted from the network of the primary to third facilities; there were 5 facilities in the Prefecture, 3 of which were localized at 4-9 km distance from FNPP and closed early after the Accident; and the secondary facility of FMU became responsible to all exposed persons. There was no death of workers of FNPP. Medical stuff also measured the ambient dose at various places near FNPP, having had risk of exposure. At the Accident, the important system of command, control and communication was found fragile and measures hereafter should be planned on assumption of the worst scenario of complete damage of the infrastructure and communication. It is desirable for Disaster Medical Assistance Team which

  8. [External quality assurance in inpatient medical rehabilitation and prevention centers for mothers, fathers and children: comparative outcome quality analyses across rehabilitation/prevention centers].

    Science.gov (United States)

    Lukasczik, M; Gerlich, C; Musekamp, G; Saupe-Heide, M; Löbmann, R; Vogel, H; Neuderth, S

    2014-01-01

    To date, there are no programs for external quality assurance for inpatient prevention and rehabilitation programs for mothers, fathers and children. Instruments for outcome quality assessment were evaluated with the goal of determining their ability to document differences between prevention/rehabilitation centers in quality-relevant outcome parameters. Referring to the ICF, relevant outcome variables were specified and operationalized using established questionnaires. Data from 45 inpatient prevention and rehabilitation centers for mothers, fathers and children were analyzed using multilevel modeling with risk adjustment. Intra-class correlations were computed to determine in which parameters differences between institutions could be found. The percentage of variability accounted for by patient vs. institution characteristics was computed while statistically controlling for relevant confounders. For prevention centers, substantial variation on the institutional level was found in 9 out of 15 parameters. Almost all institutions did not deviate significantly from the grand mean of the respective parameter. For rehabilitation centers, significant variability was found in 2 out of 10 parameters. The differences between most institutions remained within a range of expectable variability. The results imply that comparative analyses across hospitals are better suited to identify institutions with low quality rather than establish quality-based rankings of institutions. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Research Problems in Data Curation: Outcomes from the Data Curation Education in Research Centers Program

    Science.gov (United States)

    Palmer, C. L.; Mayernik, M. S.; Weber, N.; Baker, K. S.; Kelly, K.; Marlino, M. R.; Thompson, C. A.

    2013-12-01

    The need for data curation is being recognized in numerous institutional settings as national research funding agencies extend data archiving mandates to cover more types of research grants. Data curation, however, is not only a practical challenge. It presents many conceptual and theoretical challenges that must be investigated to design appropriate technical systems, social practices and institutions, policies, and services. This presentation reports on outcomes from an investigation of research problems in data curation conducted as part of the Data Curation Education in Research Centers (DCERC) program. DCERC is developing a new model for educating data professionals to contribute to scientific research. The program is organized around foundational courses and field experiences in research and data centers for both master's and doctoral students. The initiative is led by the Graduate School of Library and Information Science at the University of Illinois at Urbana-Champaign, in collaboration with the School of Information Sciences at the University of Tennessee, and library and data professionals at the National Center for Atmospheric Research (NCAR). At the doctoral level DCERC is educating future faculty and researchers in data curation and establishing a research agenda to advance the field. The doctoral seminar, Research Problems in Data Curation, was developed and taught in 2012 by the DCERC principal investigator and two doctoral fellows at the University of Illinois. It was designed to define the problem space of data curation, examine relevant concepts and theories related to both technical and social perspectives, and articulate research questions that are either unexplored or under theorized in the current literature. There was a particular emphasis on the Earth and environmental sciences, with guest speakers brought in from NCAR, National Snow and Ice Data Center (NSIDC), and Rensselaer Polytechnic Institute. Through the assignments, students

  10. Depression, social support, and clinical outcomes following lung transplantation: a single-center cohort study.

    Science.gov (United States)

    Smith, Patrick J; Snyder, Laurie D; Palmer, Scott M; Hoffman, Benson M; Stonerock, Gregory L; Ingle, Krista K; Saulino, Caroline K; Blumenthal, James A

    2017-11-12

    Depressive symptoms are common among lung transplant candidates and have been associated with poorer clinical outcomes in some studies. Previous studies have been plagued by methodologic problems, including small sample sizes, few clinical events, and uncontrolled confounders, particularly perioperative complications. In addition, few studies have examined social support as a potential protective factor. We therefore examined the association between pretransplant depressive symptoms, social support, and mortality in a large sample of lung transplant recipients. As a secondary aim, we also examined the associations between psychosocial factors, perioperative outcomes [indexed by hospital length of stay (LOS)], and mortality. We hypothesized that depression would be associated with longer LOS and that the association between depression, social support, and mortality would be moderated by LOS. Participants included lung transplant recipients, transplanted at Duke University Medical Center from January 2009 to December 2014. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI-II) and social support using the Perceived Social Support Scale (PSSS). Medical risk factors included forced vital capacity (FVC), partial pressure of carbon dioxide (PCO 2 ), donor age, acute rejection, and transplant type. Functional status was assessed using six-minute walk distance (6MWD). We also controlled for demographic factors, including age, gender, and native disease. Transplant hospitalization LOS was examined as a marker of perioperative clinical outcomes. Participants included 273 lung recipients (174 restrictive, 67 obstructive, 26 cystic fibrosis, and six "other"). Pretransplant depressive symptoms were common, with 56 participants (21%) exhibiting clinically elevated levels (BDI-II ≥ 14). Greater depressive symptoms were associated with longer LOS [adjusted b = 0.20 (2 days per 7-point higher BDI-II score), P social support (P social support were

  11. Clinical outcomes of 11,436 kidney transplants performed in a single center - Hospital do Rim

    Directory of Open Access Journals (Sweden)

    José Medina Pestana

    2017-08-01

    Full Text Available Abstract Introduction: Kidney transplantation is considered a cost-effective treatment compared to dialysis but accounts for a significant percentage of the public health care resources. Therefore, efficient systems capable of performing high number of procedures are attractive and sustainable. Objective: The aim of this study was to evaluate clinical outcomes of 11,436 kidney transplants regularly performed in a single transplant dedicated center over the last 18 years. Methods: This was a retrospective study performed in a single specialized transplant center. All consecutive patients who underwent transplantation between 08/18/1998 and 12/31/2015 were included in the analysis. Results: The annual number of transplants increased from 394 in 1999 to 886 in 2015, with a progressive reduction in the proportion of living donor kidney transplants (70% vs. 23% and yielding over 8869 patients in regular follow up. Of 11,707 kidney transplants performed, 5348 (45.7% were from living, 3614 (30.9% standard and 1618 (13.8% expanded criteria deceased donors, 856 (7.3% pediatric and 271 (2.3% simultaneous kidney-pancreas transplants. Comparing 1998-2002 and 2011-2014, five-years graft survival increased for kidney transplants performed with living donors (83.3% vs. 93.1%, p < 0.001, standard deceased donors (60.7% vs. 79.7%, p < 0.001, expanded criteria donors (46.5% vs. 71.5%, p < 0.001 and for the pediatric population (79.8% vs. 80.9%, p = 0.684. Conclusion: The implementation of a dynamic and efficacious health care system was associated with a progressive increase in the number of kidney transplants, in the cumulative number of patients in follow up and a shift from living related to deceased donor kidney transplants, with associated progressive increase in patient and graft survivals.

  12. Long-term outcomes of sigmoid diverticulitis: a single-center experience.

    Science.gov (United States)

    Mizrahi, Ido; Al-Kurd, Abbas; Chapchay, Katya; Ag-Rejuan, Yael; Simanovsky, Natalia; Eid, Ahmed; Mazeh, Haggi

    2018-01-01

    During the last decade, guidelines for the treatment of sigmoid diverticulitis have dramatically changed. The aim of this study is to report the long-term outcomes of patients treated for diverticulitis at a nonspecialized single center. After obtaining institutional review board approval, medical records of all patients admitted to our institution with the diagnosis of sigmoid diverticulitis between 1998 and 2008 were reviewed. A follow-up of at least 5 years was required. During the study period, 266 patients were admitted to our hospital due to sigmoid diverticulitis with a mean follow-up period of 120 ± 2 months. Of the entire cohort, 249 patients (93.5%) were treated conservatively and 17 (6.5%) patients required emergent surgery on initial presentation. Patients treated conservatively (n = 249) encountered a median of two recurrent episodes (range 0-4). During follow-up, none of these patients required emergent surgery, and 27 patients (11%) underwent elective surgery for recurrent episodes (n = 24), chronic smoldering disease (n = 2), and fistula (n = 1). Minor and major complication rates after elective surgery were 18.5% and 30%, respectively. Specifically, four patients (15%) suffered an anastomotic leak (AL). Late complications after elective surgery occurred in 33% of patients including incisional hernias (11%), bowel obstruction (3.7%), anastomotic stenosis (3.7%), and recurrent diverticulitis (15%). Patients treated conservatively during their index admission for sigmoid diverticulitis do not require emergent surgery during long-term follow-up and the majority of patients (89%) do not require elective surgery. Elective sigmoidectomy at nonspecialized centers may result in high rates of recurrent diverticulitis (15%) and anastomotic leak (15%). Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center.

    Science.gov (United States)

    Guimarães Filho, Gilberto Campos; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga

    2015-02-03

    Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective: Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results: We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.Fundamento: A hipertensão arterial é um problema de saúde pública devido à sua elevada prevalência, baixa taxa de controle e complicações cardiovasculares. Objetivo: Avaliar o controle da pressão arterial (PA) e desfechos cardiovasculares em pacientes atendidos no Centro de Referência em Hipertensão e Diabetes, localizado em uma cidade de médio porte da Região Centro-Oeste do Brasil. Métodos: Estudo de base populacional, que comparou pacientes matriculados no serviço no momento de sua admissão e após seguimento por período m

  14. Heart transplant outcomes in recipients of Centers for Disease Control (CDC) high risk donors.

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    Tsiouris, Athanasios; Wilson, Lynn; Sekar, Rajesh B; Mangi, Abeel A; Yun, James J

    2016-12-01

    A lack of donor hearts remains a major limitation of heart transplantation. Hearts from Centers for Disease Control (CDC) high-risk donors can be utilized with specific recipient consent. However, outcomes of heart transplantation with CDC high-risk donors are not well known. We sought to define outcomes, including posttransplant hepatitis and human immunodeficiency virus (HIV) status, in recipients of CDC high-risk donor hearts at our institution. All heart transplant recipients from August 2010 to December 2014 (n = 74) were reviewed. Comparison of 1) CDC high-risk donor (HRD) versus 2) standard-risk donor (SRD) groups were performed using chi-squared tests for nominal data and Wilcoxon two-sample tests for continuous variables. Survival was estimated with Kaplan-Meier curves. Of 74 heart transplant recipients reviewed, 66 (89%) received a SRD heart and eight (11%) received a CDC HRD heart. We found no significant differences in recipient age, sex, waiting list 1A status, pretransplant left ventricular assist device (LVAD) support, cytomegalovirus (CMV) status, and graft ischemia times (p = NS) between the HRD and SRD groups. All of the eight HRD were seronegative at the time of transplant. Postoperatively, there was no significant difference in rejection rates at six and 12 months posttransplant. Importantly, no HRD recipients acquired hepatitis or HIV. Survival in HRD versus SRD recipients was not significantly different by Kaplan-Meier analysis (log rank p = 0.644) at five years posttransplant. Heart transplants that were seronegative at the time of transplant had similar posttransplant graft function, rejection rates, and five-year posttransplant survival versus recipients of SRD hearts. At our institution, no cases of hepatitis or HIV occurred in HRD recipients in early follow-up. © 2016 Wiley Periodicals, Inc.

  15. Management and outcomes of treating pediatric medulloblastoma: an eight years' experience in an Iranian pediatric center.

    Science.gov (United States)

    Mehrvar, Azim; Tashvighi, Maryam; Hedayati Asl, Amir Abbas; Niktoreh-Mofrad, Naghmeh; Mehrvar, Narjes; Afsar, Negar; Naderi, Ali; Allebouyeh, Mardawig; Qaddoumi, Ibrahim; Faranoush, Mohammad

    2018-04-01

    The clinical management of pediatric medulloblastoma requires a multidisciplinary approach, which can be challenging, especially in low- and middle-income countries. The aim of this study was to identify current challenges and describe the treatment and outcomes of Iranian pediatric patients with medulloblastoma who were referred to our center in Tehran, Iran. Our retrospective review included 126 patient records from April 2007 to May 2015. The records were analyzed for epidemiologic features, treatment modalities, overall survival, and progression-free survival. Data were analyzed using SPSS 22.0 software. Median age at diagnosis was 6 years (male:female ratio, 2.3:1). At the time of diagnosis, 7 patients were 2 years or younger, and 76 (60.3%) were categorized as having high-risk disease. Overall, 100 patients had gross or near-total surgical resection. Cerebral spinal fluid involvement was detected in 22.2% of the patients tested, and spinal involvement was detected in 25% of the patients who underwent spinal MRI. Metastasis stages at the time of diagnosis were as follows: M0: 48.4% patients, M1: 16.7%, M2: 5.5%, and M3: 21.4%. Median times of follow-up and progression-free survival were 16 and 12 months, respectively. Probability of 7-year overall survival and progression-free survival were 59 and 53.8%, respectively. Results of the current retrospective study emphasize the need for implementing measures to improve outcome for our patients with medulloblastoma. Such measures include a multidisciplinary approach, unified national treatment guidelines, better disease and metastasis staging, twinning initiatives, and seeking a second opinion when needed.

  16. Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

    Directory of Open Access Journals (Sweden)

    Semra Eroglu

    2015-11-01

    Full Text Available Aim: The purpose of this study was to investigate the association between maternal-fetal outcomes and the severity of preeclampsia. Material and Method: A total of 528 singleton pregnancies diagnosed with preeclampsia, severe preeclampsia or HELLP syndrome with pregnancies >24 weeks of gestation were retrospectively evaluated. For each patient, maternal age, gravidity, previous obstetric history, family history, gestational age at the time of hospitalization, systolic and diastolic blood pressures, presence of severe preeclampsia symptoms, laboratory values, dexamethasone use for the treatment of thrombocytopenia, route of delivery, maternal and perinatal outcomes were recorded. Results: Within the study period, the occurences of preeclampsia, HELLP syndrome and severe preeclampsia were 1.4%, 0.12% and 0.57%, respectively. In patients with HELLP syndrome, cesarean delivery rate, blood product transfusion, acute renal failure, liver function tests, D-dimer levels, neonatal respiratory distress syndrome (RDS, necrotizing enterocolitis (NEC, preterm retinopathy, pulmonary hemorrhage and sepsis occurrences, were significantly higher than in patients with mild and severe preeclampsia. On the contrary, platelet counts were significantly lower . In patients with mild preeclampsia, gestational age at the time of delivery, vaginal delivery rate, 1 and 5 minute APGAR score and newborn birthweight were significantly higher when compared to patients with severe preeclampsia or HELLP syndrome. In contrast, systolic and diastolic blood pressures, neonatal intensive care unit admission rate, hospital stay, protein levels in 24 hr urine, and maternal hemoglobin levels were significantly lower in this group. Discussion: In the present study, it was found that HELLP syndrome was more frequently associated with maternal complications and neonatal morbidities. For the prevention of morbidities due to these unpredictable syndromes with unclear etiologies

  17. The objective and subjective outcome of orthodontic care in one municipal health center.

    Science.gov (United States)

    Hirvinen, Heljä; Heikinheimo, Kaisa; Svedström-Oristo, Anna-Liisa

    2012-01-01

    The aim of this study was to assess the outcome of orthodontic care in one municipal health center. The material consisted of one age-cohort of 15-16 year-old adolescents (n = 67). Of them, 97% participated in a clinical examination. The final group included in the study consisted of 61 adolescents (91% of the whole age cohort). The occlusions were evaluated applying the Occlusal Morphology and Function Index (OMFI), the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Moreover, all adolescents filled in a semi-structured questionnaire enquiring about their satisfaction with the function and appearance of their own dentition and self-perceived orthodontic treatment need. They also scored their own dental appearance on a Visual Analog Scale (VAS). Of the adolescents, 42% had received orthodontic treatment, while 58% were untreated. All morphological criteria of the OMFI were met by 58% of orthodontically treated and 49% of untreated adolescents and all functional criteria by 67% and 57%, respectively. Treatment need was registered in two of the treated adolescents (7%) and five of the untreated adolescents (14%). Treated adolescents were more often satisfied with their dental appearance than untreated adolescents (p = 0.034). In both groups, satisfaction with the function was high (93%). Orthodontic treatment seems to improve both occlusal morphology and function. The high satisfaction with one's own dental appearance among the treated adolescents is worth noting.

  18. Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center.

    Science.gov (United States)

    Farooq, Asim V; Patel, Rakesh M; Lin, Amy Y; Setabutr, Pete; Sartori, Juliana; Aakalu, Vinay K

    2015-06-01

    To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center. Retrospective case series. From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn's disease. Another patient had a history of alcoholic liver cirrhosis, Crohn's disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization. Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.

  19. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.

    Science.gov (United States)

    Concannon, Thomas W; Fuster, Melissa; Saunders, Tully; Patel, Kamal; Wong, John B; Leslie, Laurel K; Lau, Joseph

    2014-12-01

    We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.

  20. Priorities for Patient-Centered Outcomes Research: The Views of Minority and Underserved Communities.

    Science.gov (United States)

    Goold, Susan Dorr; Myers, C Daniel; Szymecko, Lisa; Cunningham Collins, Carla; Martinez, Sal; Ledón, Charo; Campbell, Terrance R; Danis, Marion; Cargill, Stephanie Solomon; Kim, Hyungjin Myra; Rowe, Zachary

    2017-04-01

    To learn how minority and underserved communities would set priorities for patient-centered outcomes research (PCOR). Sixteen groups (n = 183) from minority and underserved communities in two states deliberated about PCOR priorities using the simulation exercise CHoosing All Together (CHAT). Most participants were minority, one-third reported income research agendas and interviews with community leaders, clinicians, and key informants. Tablet-based CHAT collected demographic information, individual priorities before and after group deliberation, and groups' priorities. Individuals and groups prioritized research on Quality of Life, Patient-Doctor, Access, Special Needs, and (by total resources spent) Compare Approaches. Those with less than a high school education were less likely to prioritize New Approaches, Patient-Doctor, Quality of Life, and Families/Caregivers. Blacks were less likely to prioritize research on Causes of Disease, New Approaches, and Compare Approaches than whites. Compare Approaches, Special Needs, Access, and Families/Caregivers were significantly more likely to be selected by individuals after compared to before deliberation. Members of underserved communities, in informed deliberations, prioritized research on Quality of Life, Patient-Doctor, Special Needs, Access, and Compare Approaches. © Health Research and Educational Trust.

  1. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

    Directory of Open Access Journals (Sweden)

    Aysha Almas

    2014-01-01

    Full Text Available Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387 had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218. Per oral calcium channel blocker; 35.4% (137 and intravenous nitrate; 22.7% (88 were the most commonly administered medication in the ER. The mean (SD drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29 mm Hg and on per oral treatment was 43 (27 mm Hg. The maximum mean (SD drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51 mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24. Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  2. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

    Science.gov (United States)

    Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

    2014-01-01

    Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  3. GENDER AND SHOPPING BEHAVIOR OUTCOMES IN THE CONTEXT OF SHOPPING CENTERS

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    Ioana Nicoleta ABRUDAN

    2016-09-01

    Full Text Available Understanding consumer behavior can be divided into three parts: before visiting the stores or shopping centers, during the visit, and after. From the point of view of the final result intended by retailers, satisfying customers in terms of profitability, all three components are equally important. A relevant segmentation criterion for most products and stores is gender. Previous research suggests that gender influences shopping motivations, the way people shop and shopping behavior outcomes. The purpose of this article is to investigate if there are, indeed, differences between shopping behavior outputs of women and men (affective loyalty (satisfaction and conative loyalty, as found by certain researchers, and also in terms of the factors that influence the formation of conative loyalty. The results confirm that there are few significant differences in the satisfaction level, although for women all values are slightly higher, and none in the repurchase and recommendation intentions between the two genders. Conative loyalty formation (defined as intent to repurchase and recommend takes place differently between the two genders.

  4. Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster.

    Science.gov (United States)

    Stellman, Jeanne Mager; Smith, Rebecca P; Katz, Craig L; Sharma, Vansh; Charney, Dennis S; Herbert, Robin; Moline, Jacqueline; Luft, Benjamin J; Markowitz, Steven; Udasin, Iris; Harrison, Denise; Baron, Sherry; Landrigan, Philip J; Levin, Stephen M; Southwick, Steven

    2008-09-01

    The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.

  5. Innovative Practices to Sustain and Renew Service and Patient-centered Outcomes

    Science.gov (United States)

    Noelke, Nancy

    2014-01-01

    Background and Objectives: In integrating HeartMath into our culture at Gundersen Health System, we have a shared focus on delivering workshops and sustaining our HeartMath practices through a variety of innovative approaches. This presentation provides examples of our success in keeping the HeartMath practices alive for our staff. Gundersen is a fully integrated delivery system of 6500 employees. More than 700 medical, dental, and associate employees are distributed throughout 41 clinic locations, a 325-bed tertiary medical center, a Level II Trauma Center, Gundersen Medical Foundation, residency and medical education programs, and a clinical research program. Our service area covers 19 counties in three states, Western Wisconsin, Southeast Minnesota and Northeast Iowa. We are a physician-led organization embracing a strong administrative/medical partnership. Three parts of the 2012–2016 strategic plan apply to this initiative: Innovate to achieve service and patient-centered experience outcomes that are best in class (Outstanding Patient Experience); create a culture that embraces a passion for caring and spirit of improvement (Great Place to Work); and engage our staff to create a safe, injury-free, and healing environment for themselves, our patients, and visitors (Great Place to Work). Rollout Method: Between February 2011 and February 2013, more than 1200 employees completed HeartMath training. This initiative started with two staff members becoming HeartMathcertified trainers in January 2011. To promote leadership support for the program, the department chair MDs received HeartMath education in May 2011. Several units were identified to be the first to receive the training. As positive reviews circulated, requests for trainings were received from other departments. These included requests to customize the HeartMath offerings for leadership summits, manager meetings, new leader on-boarding, and physician and associate staff and to offer HeartMath appetizers

  6. Wound management in disaster settings.

    Science.gov (United States)

    Wuthisuthimethawee, Prasit; Lindquist, Samuel J; Sandler, Nicola; Clavisi, Ornella; Korin, Stephanie; Watters, David; Gruen, Russell L

    2015-04-01

    Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where resources and facilities are also often limited, and clear appropriate guidance is needed for early wound management. We undertook a systematic review focusing on the nature of wounds in disaster situations, and the outcomes of wound management in recent disasters. We then presented the findings to an international consensus panel with a view to formulating a guideline for the initial management of wounds by first responders and subsequent healthcare personnel as they deploy. We included 62 studies in the review that described wound care challenges in a diverse range of disasters, and reported high rates of wound infection with multiple causative organisms. The panel defined a guideline in which the emphasis is on not closing wounds primarily but rather directing efforts toward cleaning, debridement, and dressing wounds in preparation for delayed primary closure, or further exploration and management by skilled surgeons. Good wound care in disaster settings, as outlined in this article, can be achieved with relatively simple measures, and have important mortality and morbidity benefits.

  7. Which Emotional Profiles Exhibit the Best Learning Outcomes? A Person-Centered Analysis of Students' Academic Emotions

    Science.gov (United States)

    Ganotice, Fraide A., Jr.; Datu, Jesus Alfonso D.; King, Ronnel B.

    2016-01-01

    Previous studies on academic emotions have mostly used variable-centered approaches. Although these studies have elucidated the relationships between academic emotions and key academic outcomes, they cannot identify naturally-occurring groups of students defined by distinct academic emotion profiles. In this study, we adopted a person-centered…

  8. Patient-Centered Dentinal Hypersensitivity Treatment Outcomes: Results from the National Dental PBRN.

    Science.gov (United States)

    Heft, M W; Litaker, M S; Kopycka-Kedzierawski, D T; Meyerowitz, C; Chonowski, S; Yardic, R L; Gordan, V V; Mungia, R; Gilbert, G H

    2018-01-01

    Dentinal hypersensitivity (DH) can have a significant impact on oral health and functioning, and it is a clinical symptom commonly managed by dentists during routine clinical practice. DH symptoms are typically elicited by otherwise innocuous, nonpainful stimuli applied to exposed dentin (e.g., tactile stimuli, warming or cooling temperatures or air puffs). Treatment approaches have sought to directly target the dentinal pulp tissues or close dentinal tubules via dental office care and treatment services (fluoride varnishes, glutaraldehydes, bonding agents, sealants, oxalates, or lasers) or home care services (toothpastes or dentifrices containing fluoride or potassium nitrate compounds). The purpose of this prospective multicenter cohort study was to assess how community-based dentists from the National Dental Practice-Based Research Network (National Dental PBRN) manage DH and whether the effectiveness of DH treatments can be assessed in those settings. A total of 171 dentists recruited 1862 subjects with DH from their existing patients. Dentists then recommended and provided DH treatment as appropriate. Treatment choice was at the discretion of the dentists. Patients rated their DH pain at baseline and 1, 4, and 8 wk during the course of their treatments. They used pain intensity and unpleasantness visual analog scales and 4 labeled magnitude scales and rated their satisfaction with treatment after 8 wk. Patients were provided reminders postbaseline via email, texting, or voice mail. These patient-centered outcomes served as the principal measures for the assessment of treatment because treatments sought to alleviate DH symptoms. The patients with DH who reported pain reduction from dentist-provided treatments (glutaraldehyde/HEMA [hydroxyethyl methacrylate] compounds, oxalates, and bonding agents), dentists' advice and counseling regarding oral habits and diet, and patient-applied fluoride toothpaste reported a concomitant positive rating of satisfaction with

  9. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern india

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    Rautaraya Bibhudutta

    2011-12-01

    Full Text Available Abstract Background Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. Methods A retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis. Results Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997 corneal samples, 23.4% (233/997 were bacterial, 26.4% (264/997 were fungal (45 cases mixed with bacteria, 1.4% (14/997 were Acanthamoeba with or without bacteria and 23.4% (233/997 were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251 cases. Aspergillus species (27.9%, 60/215 and Fusarium species (23.2%, 50/215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264 cases. Fifty two patients (19.7%, 52/264 required therapeutic PK, 9 (3.4%, 9/264 went for evisceration, 18.9% (50/264 received glue application with bandage

  10. Final outcome of raptors admitted to the Tafira Wildlife Rehabilitation Center, Gran Canaria Island, Spain (2003–2013

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    Montesdeoca, N.

    2017-05-01

    Full Text Available The outcomes of wild raptors admitted to the Tafira Wildlife Rehabilitation Center in Gran Canaria Island, Spain, from 2003 to 2013 were analyzed using a quality auditing system based on the crude and stratified (by causes of admission rates of four final outcome categories, time until death and length of stay as quality indicators. The outcome categories were: euthanasia (Er = 19.78%; unassisted mortality during hospitalization (Mr = 22.20%; release (Rr = 57.57%; and permanent captivity (Cr = 0.46%. Taking into account the particular vulnerability of insular raptor species and the high Rr achieved, findings from this study emphasize the importance of wildlife rehabilitation centers for the medical management of injured raptors and the subsequent release of rehabilitated individuals into the wild.

  11. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

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    Abdel-Razeq H

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension

  12. Outcome after prenatal diagnosis of fetal urinary tract abnormalities: A tertiary center experience.

    Science.gov (United States)

    Özel, Ayşegül; Alıcı Davutoğlu, Ebru; Erenel, Hakan; Karslı, Mehmet Fatih; Korkmaz, Sevim Özge; Madazlı, Rıza

    2018-04-04

    With the widespread use of ultrasonography for fetal screening, the detection and management of congenital urinary tract abnormalities has become crucial. In this study, we aimed to describe the clinical approaches in patients with prenatally detected urinary tract abnormalities. This study is a retrospective, single centre study performed at a perinatology unit of an university hospital, between 2010-2016. Outcome of 124 patients were prenatally diagnosed with urinary tract abnormalities, was reported. Variables included in the analysis were fetal gender, birth week and weight, persistency and necessity surgery after birth for renal pelvic dilatation. Low risk renal pelvic dilatation was determined as an anterior-posterior diameter of 4-7 mm at 16-28 week, 7-10 mm after 28 week, whereas High risk dilatation was defined as AP measurements of ≥7 mm at 16-28 week, ≥10 mm after 28 week, respectively. The majority of patients consisted of male fetuses with bilateral pelviectasis (62.9%, 20.2%, respectively). The mean age was 28.8±6.4 years. The mean gestational age at birth was 34.2±7.8 weeks. The mean birth weight was 2593±1253.3 gr. The need for surgery was more in high risk cases than low risk cases (58.3% vs 8.7%) (p˂0.002). Patients with high risk antenatal renal pelvic dilatation required surgical treatment after delivery. Close prenatal and postnatal follow-up is mandotary in specialized centers.Perinatologists, neonatologists, pediatricians and pediatric nephrologists, and radiologists should approach by a multidisciplinary method for these children.

  13. Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery?

    Science.gov (United States)

    Al-Dajani, Mahmoud

    2017-08-01

    Because of increased attention focused on administering dexamethasone to treat third molar surgical complications, this study investigated the efficacy of single-dose dexamethasone in managing postoperative complications after impacted third molar surgery. Pain intensity and analgesic intake, patients' discomfort, limitation of oral function, and limitation of daily activities were assessed. This triple-blinded split-mouth randomized controlled clinical trial included patients 18 to 30 years old who underwent randomized bilateral extractions of impacted mandibular third molars during 2 consecutive sessions. Each patient was given a single-dose intramuscular injection of dexamethasone (0.1 mg/kg) preoperatively in 1 session and a placebo in the other session. Data were collected daily for 7 postoperative days, and 14 patient-centered outcomes were interpreted. A 2-tailed P value less than .05 was considered significant. All 32 patients (100%) enrolled completed the study. When administered dexamethasone, patients reported less pain (P ≤ .007), took fewer analgesics (P ≤ .002), reported less swelling (P ≤ .007), had less difficulty in eating (P ≤ .024), had less difficulty in enjoying food (P ≤ .005), had less difficulty in speech (P = .043), had less trismus (P = .005), were absent less from school or work (P ≤ .016), and had less disruption of daily activity (P ≤ .042). The differences between the 2 conditions in bleeding, malaise, and sleep disturbance were not significant (P > .05). Prophylactic dexamethasone administered intramuscularly before third molar surgery should be recommended as a safe and effective strategy for decreasing pain and discomfort and enhancing oral functions and daily activities, unless contraindicated. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Clinical presentation, management, and postnatal outcomes of fetal tachyarrhythmias: A 10-year single-center experience

    Directory of Open Access Journals (Sweden)

    Balaganesh Karmegeraj

    2018-01-01

    Conclusions : Aggressive TPT using combination of drugs achieves excellent pregnancy and postnatal outcomes in fetuses with tachyarrhythmia. Early diagnosis and prompt referral before hemodynamic decompensation is critical for ensuring optimal outcomes.

  15. Wildfire Disasters and Nursing.

    Science.gov (United States)

    Hanes, Patricia Frohock

    2016-12-01

    Multiple factors contribute to wildfires in California and other regions: drought, winds, climate change, and spreading urbanization. Little has been done to study the multiple roles of nurses related to wildfire disasters. Major nursing organizations support disaster education for nurses. It is essential for nurses to recognize their roles in each phase of the disaster cycle: mitigation, preparedness, response, and recovery. Skills learned in the US federal all-hazards approach to disasters can then be adapted to more specific disasters, such as wildfires, and issues affecting health care. Nursing has an important role in each phase of the disaster cycle. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network.

    Science.gov (United States)

    Redline, Susan; Baker-Goodwin, Si; Bakker, Jessie P; Epstein, Matthew; Hanes, Sherry; Hanson, Mark; Harrington, Zinta; Johnston, James C; Kapur, Vishesh K; Keepnews, David; Kontos, Emily; Lowe, Andy; Owens, Judith; Page, Kathy; Rothstein, Nancy

    2016-07-15

    Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient "researchers" are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the "customer." To date, however, the "patient voice" largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care. © 2016 American Academy of Sleep Medicine.

  17. Statistical Machines for Trauma Hospital Outcomes Research: Application to the PRospective, Observational, Multi-Center Major Trauma Transfusion (PROMMTT Study.

    Directory of Open Access Journals (Sweden)

    Sara E Moore

    Full Text Available Improving the treatment of trauma, a leading cause of death worldwide, is of great clinical and public health interest. This analysis introduces flexible statistical methods for estimating center-level effects on individual outcomes in the context of highly variable patient populations, such as those of the PRospective, Observational, Multi-center Major Trauma Transfusion study. Ten US level I trauma centers enrolled a total of 1,245 trauma patients who survived at least 30 minutes after admission and received at least one unit of red blood cells. Outcomes included death, multiple organ failure, substantial bleeding, and transfusion of blood products. The centers involved were classified as either large or small-volume based on the number of massive transfusion patients enrolled during the study period. We focused on estimation of parameters inspired by causal inference, specifically estimated impacts on patient outcomes related to the volume of the trauma hospital that treated them. We defined this association as the change in mean outcomes of interest that would be observed if, contrary to fact, subjects from large-volume sites were treated at small-volume sites (the effect of treatment among the treated. We estimated this parameter using three different methods, some of which use data-adaptive machine learning tools to derive the outcome models, minimizing residual confounding by reducing model misspecification. Differences between unadjusted and adjusted estimators sometimes differed dramatically, demonstrating the need to account for differences in patient characteristics in clinic comparisons. In addition, the estimators based on robust adjustment methods showed potential impacts of hospital volume. For instance, we estimated a survival benefit for patients who were treated at large-volume sites, which was not apparent in simpler, unadjusted comparisons. By removing arbitrary modeling decisions from the estimation process and concentrating

  18. Aortic Root Surgery in Marfan Syndrome: Medium-Term Outcome in a Single-Center Experience.

    Science.gov (United States)

    Attenhofer Jost, Christine H; Connolly, Heidi M; Scott, Christopher G; Ammash, Naser M; Bowen, Juan M; Schaff, Hartzell V

    2017-01-01

    The study aim was to analyze the authors' experience with aortic root surgery in Marfan syndrome (MFS), and to expand the surgical outcome data of patients meeting the Ghent criteria (Marfan registry). Analyses were performed of data acquired from MFS patients (who met the Ghent criteria), including an aortic root surgery and Kaplan-Meier survival. Between April 2004 and February 2012, a total of 59 MFS patients (mean age at surgery 36 ± 13 years) underwent 67 operations for aortic root aneurysm (n = 52), aortic valve (AV) regurgitation (n = 15), acute aortic dissection (n = 2), and/or mitral valve (MV) regurgitation resulting from MV prolapse (n = 7). Of 59 initial operations, 21 (36%) involved AV-replacing root surgery, 38 (64%) AV-sparing root surgery, seven (12%) aortic arch or hemi-arch repair, and five (8%) simultaneous MV surgery. There were no early mortalities. The mean follow up was 6.8 ± 1.2 years, with five deaths (8%) and a relatively low reoperation rate (10 reoperations in nine patients; 14%). Seven reoperations involved AV or aortic root surgery (including four for AV regurgitation following failed AV-sparing surgery), two MV repair/replacements, and one coronary artery bypass graft. Eight patients (21%) with AV-sparing surgery had moderate/severe AV regurgitation at the last follow up before re-intervention. The mean five-year freedom from postoperative death was 91.2 ± 8.8%, from cardiac reoperation 86.3 ± 4.5%, and more-than-moderate AV regurgitation 90.3 ± 4.8%. Prophylactic aortic surgery in MFS patients with AV-replacing root or AV-sparing root surgery carries a low risk of operative morbidity and death when performed at an experienced center. AV-sparing root surgery increases the risk of AV regurgitation and, possibly, of re-intervention. Regular clinical follow up is important after any aortic root surgery in MFS patients, with a delineation of risk factors for AV regurgitation after AV rootsparing surgery.

  19. Coordinating Military Response to Disasters

    Science.gov (United States)

    2016-01-22

    transportation and communications to logistics management and public safety and security. But effective disaster preparedness requires more than FEMA alone...intended to galvanize action by the federal government; it is also the center of facilitating an all-of-nation approach to emergency preparedness ...encompasses the Caribbean Islands outside of the U.S. territories. I will examine SOUTHCOM’s response to the earthquake in Haiti 2010 to show the lack of

  20. Patient-Centered Outcomes Measurement: Does It Require Information From Patients?

    Directory of Open Access Journals (Sweden)

    Leif I. Solberg

    2017-11-01

    Full Text Available Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR or health insurance claims. Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time period between the imaging test and survey completion. We also compared survey data with algorithmically extracted data from claims files for outcomes for which data might be available from that source. Results: Of the 16 outcomes for which patients’ survey responses were considered to be the best information source, only 2 outcomes for back pain and 3 for abdominal pain had kappa scores above a very modest level of ≥ 0.2 for chart audit of EHR data and none for algorithmically obtained EHR/claims data. Of the other 5 outcomes for which claims data were considered to be the best information source, only 2 outcomes from patient surveys and 3 outcomes from chart audits had kappa scores ≥ 0.2. Conclusions: For the types of outcomes studied here, medical record or claims data do not provide an adequate source of information except for a few outcomes where patient reports may be less accurate.

  1. Can a pediatric trauma center improve the response to a mass casualty incident?

    Science.gov (United States)

    Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S

    2012-10-01

    Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. Systematic review, level III.

  2. Sharing post-AML consolidation supportive therapy with local centers reduces patient travel burden without compromising outcomes.

    Science.gov (United States)

    Hershenfeld, Samantha A; Maki, Kimberly; Rothfels, Lana; Murray, Cindy S; Nixon, Shannon; Schimmer, Aaron D; Doherty, Mary C

    2017-08-01

    Acute myeloid leukemia (AML) is frequently treated with induction and consolidation chemotherapy. Consolidation chemotherapy can be delivered on an ambulatory basis, requiring some patients to travel long distances for treatment at specialized centers. We developed a shared care model where patients receive consolidation chemotherapy at a quaternary center, but post-consolidation supportive care at local hospitals. To evaluate the impact of our model on patient travel and outcomes we conducted a retrospective analysis of AML and acute promyelocytic leukemia patients receiving consolidation over four years at our quaternary center. 73 patients received post-consolidation care locally, and 344 at the quaternary center. Gender, age and cytogenetic risk did not significantly differ between groups. Shared care patients saved mean round trip distance of 146.5km±99.6 and time of 96.7min±63.4 compared to travelling to quaternary center. There was no significant difference in overall survival between groups, and no increased hazard of death for shared care patients. 30, 60, and 90day survival from start of consolidation was 98.6%, 97.2%, and 95.9% for shared care and 98.8%, 97.1%, and 95.3% for quaternary center patients. Thus, a model utilizing regional partnerships for AML post-consolidation care reduces travel burden while maintaining safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Conceptualizing Cold Disasters

    DEFF Research Database (Denmark)

    Lauta, Kristian Cedervall; Dahlberg, Rasmus; Vendelø, Morten Thanning

    2017-01-01

    conditions in a cold context, exemplified by the Arctic, and zooms in on Greenland to provide more specific background for the paper. The second part, Disasters in Cold Contexts, discusses “cold disasters” in relation to disaster theory, in order to, elucidate how cold disasters challenge existing...

  4. Resilience in disaster research

    DEFF Research Database (Denmark)

    Dahlberg, Rasmus; Johannessen-Henry, Christine Tind; Raju, Emmanuel

    2015-01-01

    of disaster trauma, (ii) federal policy and the US Critical Infrastructure Plan, and (iii) the building of resilient communities for disaster risk reduction practices. The three versions aim to offer characteristic expressions of resilience, as increasingly evident in current disaster literature...

  5. Impact of a large-scale natural disaster on patients with chronic obstructive pulmonary disease: the aftermath of the 2011 Great East Japan Earthquake.

    Science.gov (United States)

    Kobayashi, Seiichi; Hanagama, Masakazu; Yamanda, Shinsuke; Satoh, Hikari; Tokuda, Shinsaku; Kobayashi, Masakazu; Ueda, Shinsaku; Suzuki, Satoshi; Yanai, Masaru

    2013-03-01

    A large-scale natural disaster may exacerbate chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). The aftermath of a natural disaster can include poor access to medication, medical equipment, and medical supplies. Little is known about the impact on patients with COPD. A retrospective cohort study was conducted at a regional medical center in Ishinomaki, the area affected most severely by the Great East Japan Earthquake in 2011. The study was performed 6 months after the disaster. The characteristics, clinical courses, and outcomes of COPD patients hospitalized after emergency visits during the study period were investigated and compared. One hundred patients (112 episodes) were identified. Within a few days after the disaster, patients undergoing oxygen therapy at home came to the hospital to receive oxygen. In the subacute phase (from the third to the fifth week), the number of hospitalizations due to COPD exacerbations was significantly increased compared to the numbers observed before the earthquake (pdisaster. The incidence of cases of exacerbated COPD normalized 6 weeks after the earthquake. The large-scale natural disaster that hit Japan in 2011 had a serious negative impact on the clinical outcomes of COPD patients in the disaster-affected area. Copyright © 2012 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  6. Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.

    Science.gov (United States)

    Thornton, Patrick; McFarlin, Barbara L; Park, Chang; Rankin, Kristin; Schorn, Mavis; Finnegan, Lorna; Stapleton, Susan

    2017-01-01

    High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States. © 2016 by the American College of Nurse-Midwives.

  7. Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes.

    Science.gov (United States)

    Sloane, Philip D; Zimmerman, Sheryl; Chen, Xi; Barrick, Ann L; Poole, Patricia; Reed, David; Mitchell, Madeline; Cohen, Lauren W

    2013-07-01

    To develop and test a person-centered, evidence-based mouth care program in nursing homes. Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site. Three North Carolina nursing homes. Ninety-seven residents and six certified nursing assistants (CNAs). CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care. Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided. Outcome scores significantly improved (P oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  8. Psychological Aspects of Disaster

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Mohammadi

    2007-05-01

    Full Text Available "nHuman beings have always experienced disasters. A disaster may be brief,but its psychological effects may last for many years. These psychological effects are increasingly well documented."nDisasters affect not only those immediately involved, but also those whoknow the victims. This is perhaps particularly so when the victims arechildren. Commonly when adults hear news of disasters they ask first: What about the children? Of course, typically it is worse for the parents."nIn this article the definition and classification of disaster and the effects ofdisaster on survivors and their relatives will be discussed.

  9. Real-time Forensic Disaster Analysis

    Science.gov (United States)

    Wenzel, F.; Daniell, J.; Khazai, B.; Mühr, B.; Kunz-Plapp, T.; Markus, M.; Vervaeck, A.

    2012-04-01

    The Center for Disaster Management and Risk Reduction Technology (CEDIM, www.cedim.de) - an interdisciplinary research center founded by the German Research Centre for Geoscience (GFZ) and Karlsruhe Institute of Technology (KIT) - has embarked on a new style of disaster research known as Forensic Disaster Analysis. The notion has been coined by the Integrated Research on Disaster Risk initiative (IRDR, www.irdrinternational.org) launched by ICSU in 2010. It has been defined as an approach to studying natural disasters that aims at uncovering the root causes of disasters through in-depth investigations that go beyond the reconnaissance reports and case studies typically conducted after disasters. In adopting this comprehensive understanding of disasters CEDIM adds a real-time component to the assessment and evaluation process. By comprehensive we mean that most if not all relevant aspects of disasters are considered and jointly analysed. This includes the impact (human, economy, and infrastructure), comparisons with recent historic events, social vulnerability, reconstruction and long-term impacts on livelihood issues. The forensic disaster analysis research mode is thus best characterized as "event-based research" through systematic investigation of critical issues arising after a disaster across various inter-related areas. The forensic approach requires (a) availability of global data bases regarding previous earthquake losses, socio-economic parameters, building stock information, etc.; (b) leveraging platforms such as the EERI clearing house, relief-web, and the many sources of local and international sources where information is organized; and (c) rapid access to critical information (e.g., crowd sourcing techniques) to improve our understanding of the complex dynamics of disasters. The main scientific questions being addressed are: What are critical factors that control loss of life, of infrastructure, and for economy? What are the critical interactions

  10. The Central American Network for Disaster and Health Information.

    Science.gov (United States)

    Arnesen, Stacey J; Cid, Victor H; Scott, John C; Perez, Ricardo; Zervaas, Dave

    2007-07-01

    This paper describes an international outreach program to support rebuilding Central America's health information infrastructure after several natural disasters in the region, including Hurricane Mitch in 1998 and two major earthquakes in 2001. The National Library of Medicine joined forces with the Pan American Health Organization/World Health Organization, the United Nations International Strategy for Disaster Reduction, and the Regional Center of Disaster Information for Latin America and the Caribbean (CRID) to strengthen libraries and information centers in Central America and improve the availability of and access to health and disaster information in the region by developing the Central American Network for Disaster and Health Information (CANDHI). Through CRID, the program created ten disaster health information centers in medical libraries and disaster-related organizations in six countries. This project served as a catalyst for the modernization of several medical libraries in Central America. The resulting CANDHI provides much needed electronic access to public health "gray literature" on disasters, as well as access to numerous health information resources. CANDHI members assist their institutions and countries in a variety of disaster preparedness activities through collecting and disseminating information.

  11. Neonatal and Pregnancy Outcome in Primary Antiphospholipid Syndrome: A 10-year Experience in One Medical Center

    Directory of Open Access Journals (Sweden)

    An-Kuo Chou

    2009-08-01

    Conclusions: This limited study suggests that neonates born to mothers with primary APS are at risk of prematurity, being small for gestational age, and having thrombocytopenia. Further large, prospective studies are required to better define the perinatal outcomes.

  12. A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency.

    Science.gov (United States)

    Wang, Sheng; Feng, Ling

    2017-10-01

    To compare maternal and perinatal outcomes after emergency cerclage with those after elective cerclage. In a retrospective review, data were assessed from women with a viable singleton pregnancy who underwent elective or emergency cerclage for cervical insufficiency at the Tongji Hospital, Wuhan, China, between January 2010 and July 2015. Subgroup analyses based on cervical length (CL; ≤15, 15-25, and 25-30 mm) were also conducted among women undergoing emergency cerclage. In total, 68 women underwent elective cerclage and 53 underwent emergency cerclage. The suture-to-delivery interval was significantly longer in the elective group (19.17 ± 5.86 weeks) than in the emergency group (11.29 ± 7.27 weeks; Ppregnancy length at delivery, frequency of Apgar score below 7 at 5 minutes (live births only), or birth weight (live births only). An inverse trend in the degree of CL shortening with pregnancy outcomes was observed; women with a CL of 25-30 mm had the best outcomes. Pregnancy outcomes were similar after emergency and elective cerclage. There was an inverse trend in the degree of CL shortening with pregnancy outcomes in the emergency cerclage group, with better outcomes observed for women with longer CL. © 2017 International Federation of Gynecology and Obstetrics.

  13. Disaster in Crisis

    DEFF Research Database (Denmark)

    Illner, Peer

    initiatives and bottom-up organising as the preferred method to combat disaster. Once construed as strictly a responsibility of the state, the mitigation and management of disasters has shifted since the 1970s into a matter for civil society: a shift which has been heralded as progressive, democratic...... the banner of disaster. Focussing on the modifications to disaster management in the United States between 1970 and 2012, I show how the inclusion of civil society in the provision of aid services was accompanied by a structural withdrawal of the state from disaster relief and other welfare services. I...... contextualise this withdrawal in the US government’s general turn to austerity in response to the economic crisis of the 1970s. My account couples the notion of disaster with that of economic crisis on the one hand and structural violence on the other to examine disasters as a specific problem for social...

  14. Practitioner Perspectives on a Disaster Management Architecture

    Science.gov (United States)

    Moe, K.; Evans, J. D.

    2012-12-01

    The Committee on Earth Observing Satellites (CEOS) Working Group on Information Systems and Services (WGISS) is constructing a high-level reference model for the use of satellites, sensors, models, and associated data products from many different global data and service providers in disaster response and risk assessment. To help streamline broad, effective access to satellite information, the reference model provides structured, shared, holistic views of distributed systems and services - in effect, a common vocabulary describing the system-of-systems building blocks and how they are composed for disaster management. These views are being inferred from real-world experience, by documenting and analyzing how practitioners have gone about using or providing satellite data to manage real disaster events or to assess or mitigate hazard risks. Crucial findings and insights come from case studies of three kinds of experience: - Disaster response and recovery (such as the 2008 Sichuan/Wenchuan earthquake in China; and the 2011 Tohoku earthquake and tsunami in Japan); - Technology pilot projects (such as NASA's Flood Sensor Web pilot in Namibia, or the interagency Virtual Mission Operation Center); - Information brokers (such as the International Charter: Space and Major Disasters, or the U.K.-based Disaster Management Constellation). Each of these experiences sheds light on the scope and stakeholders of disaster management; the information requirements for various disaster types and phases; and the services needed for effective access to information by a variety of users. They also highlight needs and gaps in the supply of satellite information for disaster management. One need stands out: rapid and effective access to complex data from multiple sources, across inter-organizational boundaries. This is the near-real-time challenge writ large: gaining access to satellite data resources from multiple organizationally distant and geographically disperse sources, to meet an

  15. Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions: Measuring Care Outcomes.

    Science.gov (United States)

    Pourat, Nadereh; Charles, Shana A; Snyder, Sophie

    2016-03-01

    Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare. We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles. We analyzed data from a representative population survey in California in 2009, focusing on a population with chronic condition who had a usual source of care. We used bivariate, logistic, and negative-binomial regressions. The indicators of PCMH concordant care included continuity of care (personal doctor), care coordination, and care management (individual treatment plan). Outcomes included flu shots, count of outpatient visits, any emergency department visit, timely provider communication, and confidence in self-care. We found that patients whose care was concordant with all 3 PCMH principles were more likely to receive flu shots, more outpatient care, and timely response from providers. Concordance with 2 principles led to some desired outcomes. Concordance with only 1 principle was not associated with desired outcomes. Patients who received care that met 3 key aspects of PCMH: coordination, continuity, and management, had better quality of care and more efficient use of the health care system.

  16. Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul.

    Science.gov (United States)

    Güngör, Emre Sinan; Seval, Olcay; İlhan, Gülşah; Verit, Fatma Ferda

    2018-03-01

    To compare obstetric and perinatal outcomes of Syrian refugee pregnants and Turkish counterparts who gave birth at a tertiary center in İstanbul. A retrospective study including the birth records of 704 Syrian refugees and 744 Turkish pregnant women between January 2016 and May 2017 were analyzed. Demographic data, obstetric and neonatal outcomes were compared. The primary aims of this study were to evaluate the pregnancy outcomes and cesarean rates between the groups. The secondary outcomes were the use of antenatal vitamin supplementation, hemoglobin-hematocrit values, and maternal complications. Our results showed that the use of folic acid and iron supplementation rates during pregnancy were similar between the groups (folic acid supplementation 8.1% vs 6.5%, p=0.264; iron supplementation 20.7% vs 19.6%, p=0.125; respectively for Turkish women and Syrian refugees). Cesarean rates were significantly higher for Turkish patients than in Syrian refugees (42.7% vs 32.7%; pyrian refugees (37.7±2.3 vs 36.4±2.3 weeks, pyrian refugees, respectively, p=0.105). Although obstetric complications were seen more often in Syrian refugees, it did not reach statistical difference (9.7% vs 8.1%, respectively, p=0.285). Syrian refugees use antenatal vitamin supplementations at similar rates to Turkish citizens and obstetric and perinatal outcomes are similar between the groups.

  17. Informal Networks in Disaster Medicine.

    Science.gov (United States)

    Bdeir, Fadl; Crawford, John W; Hossain, Liaquat

    2017-06-01

    Our study of informal networks aimed to explore information-sharing environments for the management of disaster medicine and public health preparedness. Understanding interagency coordination in preparing for and responding to extreme events such as disease outbreaks is central to reducing risks and coordination costs. We evaluated the pattern of information flow for actors involved in disaster medicine through social network analysis. Social network analysis of agencies can serve as a basis for the effective design and reconstruction of disaster medicine response coordination structures. This research used new theoretical approaches in suggesting a framework and a method to study the outcome of complex inter-organizational networks in coordinating disease outbreak response. We present research surveys of 70 health professionals from different skill sets and organizational positions during the swine influenza A (H1N1) PDM09 2009 pandemic. The survey and interviews were designed to collect both qualitative and quantitative data in order to build a comprehensive and in-depth understanding of the dynamics of the inter-organizational networks that evolved during the pandemic. The degree centrality of the informal network showed a positive correlation with performance, in which the ego's performance is related to the number of links he or she establishes informally-outside the standard operating structure during the pandemic. Informal networks facilitate the transmission of both strong (ie, infections, confirmed cases, deaths in hospital or clinic settings) and weak (ie, casual acquaintances) ties. The results showed that informal networks promoted community-based ad hoc and formal networks, thus making overall disaster medicine and public health preparedness more effective. (Disaster Med Public Health Preparedness. 2017;11:343-354).

  18. Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes--A Randomized Controlled Trial.

    Science.gov (United States)

    Santos, Catarina; Rodrigues, Fátima; Santos, Joana; Morais, Luísa; Bárbara, Cristina

    2015-11-01

    Exercise training is an important component of pulmonary rehabilitation, but it remains questionable how training intensity affects patient-centered outcomes. The aim of this study was to compare the effects of 2 aerobic training intensities on health-related quality of life (HRQOL), symptom control, and exercise tolerance in subjects with COPD. Thirty-four subjects with mild to very severe COPD participated in an equivalence/non-inferiority randomized controlled trial with a parallel group blinded to 60 or 80% maximum work rate (W max) aerobic training intensity. The intervention was an out-patient pulmonary rehabilitation program conducted 3 times/week for 8 weeks. Outcomes were assessed with the St George Respiratory Questionnaire (primary outcome), Mahler's dyspnea index, London Chest Activity of Daily Living scale, 6-min walk test, and constant-load and incremental exercise tests. Subjects were randomly allocated to aerobic training intensity of 60% W max (group 1, n = 17) or 80% W max (group 2, n = 17). Although there were significant improvements in all outcomes for both groups, there were no between-group differences in mean change in the St George Respiratory Questionnaire (P = .31, 95% CI -12.0 to 3.9), Mahler's dyspnea index (P = .38), London Chest Activity of Daily Living scale (P = .92), 6-min walk test (P = .50, 95% CI 6.2-71.1), constant-load exercise test (P = .50), and incremental exercise test (P = .12). There was only one exercise-related adverse event of cardiac symptoms. Aerobic training intensity of at least 60% W max has a positive impact on COPD patient-centered outcomes, with no additional benefit of increasing intensity to 80% W max in HRQOL, symptom control, and exercise tolerance, challenging the present clinical attitude of rehabilitation professionals. (ClinicalTrials.gov registration NCT01944072.). Copyright © 2015 by Daedalus Enterprises.

  19. Assessing Person-Centered Outcomes in Practice Research: A Latent Transition Profile Framework

    Science.gov (United States)

    Thompson, Aaron M.; Macy, Rebecca J.; Fraser, Mark W.

    2011-01-01

    Advances in statistics provide new methods for analyzing practice data. These advances include person-centered methods (PCMs) that identify subgroups of research participants with similar characteristics. PCMs derive from a frame of reference that is similar to the risk factor perspective in practice. In practice, the delivery of services is often…

  20. Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation.

    Science.gov (United States)

    Wehbe-Janek, Hania; Markova, Tsveti; Polis, Rachael L; Peters, Marguerite; Liu, Yang

    2016-01-01

    Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers.

  1. Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

    Energy Technology Data Exchange (ETDEWEB)

    Ohri, Nitin [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Rapkin, Bruce D. [Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Guha, Chandan; Kalnicki, Shalom [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States); Garg, Madhur, E-mail: mgarg@montefiore.org [Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (United States)

    2016-06-01

    Purpose: To examine associations between radiation therapy (RT) noncompliance and clinical outcomes. Methods and Materials: We reviewed all patients who completed courses of external beam RT with curative intent in our department from the years 2007 to 2012 for cancers of the head and neck, breast, lung, cervix, uterus, or rectum. Patients who missed 2 or more scheduled RT appointments (excluding planned treatment breaks) were deemed noncompliant. Univariate, multivariable, and propensity-matched analyses were performed to examine associations between RT noncompliance and clinical outcomes. Results: Of 1227 patients, 266 (21.7%) were noncompliant. With median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. In univariate analyses, RT noncompliance was associated with increased recurrence risk (5-year cumulative incidence 16% vs 7%, P<.001), inferior recurrence-free survival (5-year actuarial rate 63% vs 79%, P<.001), and inferior overall survival (5-year actuarial rate 72% vs 83%, P<.001). In multivariable analyses that were adjusted for disease site and stage, comorbidity score, gender, ethnicity, race, and socioeconomic status (SES), RT noncompliance was associated with inferior recurrence, recurrence-free survival, and overall survival rates. Propensity score–matched models yielded results nearly identical to those seen in univariate analyses. Low SES was associated with RT noncompliance and was associated with inferior clinical outcomes in univariate analyses, but SES was not associated with inferior outcomes in multivariable models. Conclusion: For cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have been observed linking SES and

  2. Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

    International Nuclear Information System (INIS)

    Ohri, Nitin; Rapkin, Bruce D.; Guha, Chandan; Kalnicki, Shalom; Garg, Madhur

    2016-01-01

    Purpose: To examine associations between radiation therapy (RT) noncompliance and clinical outcomes. Methods and Materials: We reviewed all patients who completed courses of external beam RT with curative intent in our department from the years 2007 to 2012 for cancers of the head and neck, breast, lung, cervix, uterus, or rectum. Patients who missed 2 or more scheduled RT appointments (excluding planned treatment breaks) were deemed noncompliant. Univariate, multivariable, and propensity-matched analyses were performed to examine associations between RT noncompliance and clinical outcomes. Results: Of 1227 patients, 266 (21.7%) were noncompliant. With median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. In univariate analyses, RT noncompliance was associated with increased recurrence risk (5-year cumulative incidence 16% vs 7%, P<.001), inferior recurrence-free survival (5-year actuarial rate 63% vs 79%, P<.001), and inferior overall survival (5-year actuarial rate 72% vs 83%, P<.001). In multivariable analyses that were adjusted for disease site and stage, comorbidity score, gender, ethnicity, race, and socioeconomic status (SES), RT noncompliance was associated with inferior recurrence, recurrence-free survival, and overall survival rates. Propensity score–matched models yielded results nearly identical to those seen in univariate analyses. Low SES was associated with RT noncompliance and was associated with inferior clinical outcomes in univariate analyses, but SES was not associated with inferior outcomes in multivariable models. Conclusion: For cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have been observed linking SES and

  3. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Specific Providers VA Providers and Staff Disaster Responders Medical Doctors Community Providers and Clergy Co-Occurring Conditions Continuing Education Publications List of Center Publications Articles by Center Staff Clinician’s Trauma Update PTSD Research ...

  4. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... PTSD Consultation For Specific Providers VA Providers and Staff Disaster Responders Medical Doctors Community Providers and Clergy ... Publications List of Center Publications Articles by Center Staff Clinician’s Trauma Update PTSD Research Quarterly Publications Search ...

  5. Adult Day Center Programs and Their Associated Outcomes on Clients, Caregivers, and the Health System: A Scoping Review.

    Science.gov (United States)

    Ellen, Moriah E; Demaio, Peter; Lange, Ariella; Wilson, Michael G

    2017-11-10

    Adult day centers (ADCs) offer a heterogeneous group of services that provide for the daily living, care, nutritional, and social needs of older adults. We sought to conceptually map and identify key gaps and findings from literature focused on ADCs, including the types of programs that exist and their associated outcomes on improving health and strengthening health systems. We conducted a scoping review by searching 5 databases for studies evaluating the outcomes of ADCs specifically for community-dwelling older adults. Included studies were conceptually mapped according to the methods used, type of outcome(s) assessed, study population, disease focus, service focus, and health system considerations. The mapping was used to derive descriptive analyses to profile the available literature in the area. ADC use has positive health-related, social, psychological, and behavioral outcomes for care recipients and caregivers. There is a substantial amount of literature available on some ADC use outcomes, such as health-related, satisfaction-related and psychological and behavioral outcomes, while less research exists on issues of accessibility and cost-effectiveness. As the population ages, policymakers must carefully consider how ADCs can best serve each user and their caregivers with their unique circumstances. ADCs have the potential to help shape health system interventions, especially those targeting caregivers and people requiring long-term care support. Due to the variation among types of ADC programs, future research on ADCs should consider different characteristics of ADC programs to better contextualize their results. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida.

    Science.gov (United States)

    Kinsell, Heidi S; Hall, Allyson G; Harman, Jeffrey S; Tewary, Sweta; Brickman, Andrew

    2017-10-01

    Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups.

  7. Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.

    Science.gov (United States)

    Rossetti, Andrea O; Tovar Quiroga, Diego F; Juan, Elsa; Novy, Jan; White, Roger D; Ben-Hamouda, Nawfel; Britton, Jeffrey W; Oddo, Mauro; Rabinstein, Alejandro A

    2017-07-01

    The prognostic role of electroencephalography during and after targeted temperature management in postcardiac arrest patients, relatively to other predictors, is incompletely known. We assessed performances of electroencephalography during and after targeted temperature management toward good and poor outcomes, along with other recognized predictors. Cohort study (April 2009 to March 2016). Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Mayo Clinic, Rochester, MN). Consecutive comatose adults admitted after cardiac arrest, identified through prospective registries. All patients were managed with targeted temperature management, receiving prespecified standardized clinical, neurophysiologic (particularly, electroencephalography during and after targeted temperature management), and biochemical evaluations. We assessed electroencephalography variables (reactivity, continuity, epileptiform features, and prespecified "benign" or "highly malignant" patterns based on the American Clinical Neurophysiology Society nomenclature) and other clinical, neurophysiologic (somatosensory-evoked potential), and biochemical prognosticators. Good outcome (Cerebral Performance Categories 1 and 2) and mortality predictions at 3 months were calculated. Among 357 patients, early electroencephalography reactivity and continuity and flexor or better motor reaction had greater than 70% positive predictive value for good outcome; reactivity (80.4%; 95% CI, 75.9-84.4%) and motor response (80.1%; 95% CI, 75.6-84.1%) had highest accuracy. Early benign electroencephalography heralded good outcome in 86.2% (95% CI, 79.8-91.1%). False positive rates for mortality were less than 5% for epileptiform or nonreactive early electroencephalography, nonreactive late electroencephalography, absent somatosensory-evoked potential, absent pupillary or corneal reflexes, presence of myoclonus, and neuron-specific enolase greater than 75 µg/L; accuracy was highest for

  8. Learning Resources Centers and Their Effectiveness on Students’ Learning Outcomes: A Case-Study of an Omani Higher Education Institute

    Directory of Open Access Journals (Sweden)

    Peyman Nouraey

    2017-06-01

    Full Text Available The study aimed at investigating the use and effectiveness of a learning resources center, which is generally known as a library. In doing so, eight elements were investigated through an author-designed questionnaire. Each of these elements tended to delve into certain aspects of the afore-mentioned center. These elements included a students’ visits frequency, b availability of books related to modules, c center facilities, d use of discussion rooms, e use of online resources, f staff cooperation, g impact on knowledge enhancement, and, h recommendation to peers. Eighty undergraduate students participated in the study. Participants were then asked to read the statements carefully and choose one of the five responses provided, ranging from strongly agree to strongly disagree. Data were analyzed based on 5-point Likert Scale. Findings of the study revealed that participants were mostly in agreement with all eight statements provided in the questionnaire, which were interpreted as positive feedbacks from the students. Then, the frequencies of responses by the participants were reported. Finally, the results were compared and contrasted and related discussions on the effectiveness of libraries and learning resources centers on students’ learning performances and outcomes were made.

  9. The diabetes healthy outcomes program: results of free health care for uninsured at a federally qualified community health center.

    Science.gov (United States)

    Belue, Rhonda; Figaro, M Kathleen; Peterson, Jeannine; Wilds, Christina; William, Parnitha

    2014-01-01

    Uninsured patients with diabetes are at increased risk for poor outcomes and often have limited access to health and prescription services necessary to manage diabetes. Hamilton Health Center, a federally qualified community health center, with support from the Highmark Foundation, implemented a Diabetes Healthy Outcomes Program (DHOP) for uninsured patients. To evaluate the effectiveness of DHOP that is designed to provide health care and supportive services for uninsured diabetic patients at a federally qualified community health center. Mixed quantitative and qualitative analyses of participant outcomes and satisfaction were used to assess program effectiveness. A total of 189 participants enrolled in DHOP over 2 years. Thirty-four (18%) participants had adequate glycemic control with hemoglobin A1c (HbA1c) ≤ 7%. Overall, 105 participants received prescription drugs, 101 participants received eye care services, 23 participants received dental services, 45 received podiatry services, 37 received nutrition services, and 28 patients engaged in an exercise program. More participants (38%, 34) had controlled diabetes mellitus at study start than at the end (28%, 25). However, 30% versus 17% of participants with 2 HbA1c measurements achieved or maintained HbA1c ≤ 7% by the end of the program compared with the start. Participants who accessed more services were more likely to achieve glycemic control as measured by HbA1c (P > .01). Although 30% of participants improved or maintained glycemic control over 2 years, more were uncontrolled at the end than at study start. Participants who accessed more primary and specialty care services were more likely to achieve glycemic control. Multidisciplinary care may improve diabetes control in low-income patients.

  10. Does cutaneous lupus erythematosus have more favorable pregnancy outcomes than systemic disease? A two-center study.

    Science.gov (United States)

    Hamed, Hossam O; Ahmed, Salah R; Alzolibani, Abdallatif; Kamal, Manal M; Mostafa, Marwa S; Gamal, Rania M; Atallah, Dalia A A; Abd-El-Aall, Diaa-Eldeen M

    2013-08-01

    To compare pregnancy outcomes in cutaneous lupus erythematosus (CLE) with systemic lupus erythematosus (SLE) and healthy pregnant women. Cohort comparative study. Two university maternity centers in Saudi Arabia and Egypt. Pregnant women with CLE and SLE and healthy pregnant women. Over a three-year period, 201 participants were allocated to three groups: group 1 (n = 67) contained women with CLE, group 2 (n = 67) women with SLE, and group 3 healthy controls (n = 67). Diagnosis of lupus erythematosus was based on American College of Rheumatology criteria. All participants were followed until delivery. Lupus exacerbation was evaluated by Lupus Activity Index score. ANOVA and chi-squared tests were used to compare obstetrical and neonatal outcomes, and regression analysis was used to define independent factors of adverse pregnancy outcomes. Pregnancy losses, preterm labor, intrauterine growth restriction, preeclampsia, neonatal intensive care unit admissions, cesarean sections and lupus exacerbations. There was no significant difference between groups 1 and 3 in rates of pregnancy loss, preterm labor, preeclampsia, intrauterine growth restriction and neonatal intensive care admission. Group 1 had lower pregnancy loss (p = 0.005), growth restriction (p = 0.001), preeclampsia (p = 0.05), neonatal intensive care admissions (p = 0.001), cesarean section (p = 0.03), lupus exacerbations (p = 0.05) and anti-phospholipid antibodies (p = 0.02) compared with group 2. In groups 1 and 2, lupus exacerbation and anti-phospholipid antibodies were significant independent factors for adverse outcomes. Cutaneous lupus erythematosus means comparable pregnancy outcomes to those of the healthy population. Lower rates of disease exacerbation and anti-phospholipid antibodies are potential factors for better pregnancy outcome in CLE compared with SLE. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Caudate lobe resections: a single-center experience and evaluation of factors predictive of outcomes

    OpenAIRE

    Philips, Prejesh; Farmer, Russell W; Scoggins, Charles R; McMasters, Kelly M; Martin, Robert CG

    2013-01-01

    Background Despite the increasing frequency of liver resection for multiple types of disease, caudate lobe resection remains a rare surgical event. The goal of this study is to review our experience and evaluate possible predictors of adverse outcomes in patients undergoing caudate lobectomy. Methods We reviewed a 1,900-patient prospective hepato-pancreatico-biliary database from January 2000 to December 2011, identifying 36 hepatectomy patients undergoing caudate lobe resection. Clinicopatho...

  12. Role of different vascular approaches on transcatheter aortic valve implantation outcome: a single-center study.

    Science.gov (United States)

    Adamo, Marianna; Fiorina, Claudia; Curello, Salvatore; Maffeo, Diego; Chizzola, Giuliano; Di Matteo, Gerardo; Mastropierro, Rosa; Nardi, Matilde; Cervi, Edoardo; De Cicco, Giuseppe; Chiari, Ermanna; Curnis, Antonio; Bonardelli, Stefano; Coletti, Giuseppe; Manzato, Aldo; Metra, Marco; Ettori, Federica

    2015-04-01

    To compare different vascular approaches on clinical outcome of patients undergoing transcatheter aortic valve implantation (TAVI) with self-expandable bioprosthesis. We included all the patients undergoing CoreValve implantation at our institute between September 2007 and March 2014. They were divided into four groups based on the vascular approach: percutaneous transfemoral (pTF), cut-down transfemoral (cTF), transaxillary (TAx) and transaortic (TAo). Clinical outcomes were evaluated according to Valve Academic Research Consortium-2 recommendations. Out of 322 consecutive patients, 170 (53%) underwent pTF, 76 (23%) cTF, 32 (10%) TAx and 44 (14%) TAo approach. Although the TAx and TAo patients had a higher risk profile, they had a similar outcome compared with the pTF and cTF groups; in particular, there were no differences regarding cardiovascular and all-cause mortality at 30 days, 1 and 2 years, as well as stroke, myocardial infarction, bleeding, major vascular complications, permanent pacemaker implantation and acute kidney injury rates. The observed device success rate was higher in the TAo than in the other approaches (88.6 versus 65.9, 68.7 and 76.3% in the pTF, cTF and TAx groups, respectively; P = 0.019). No differences occurred regarding 30-day early safety and 1-year clinical efficacy across the four groups. Fluoroscopy time, amount of contrast medium used and minor vascular complications were significantly higher in pTF patients, as well as in-hospital stay in the TAo group. Atrial fibrillation and prosthetic valve regurgitation, but not the vascular approach, were independent predictors of all-cause mortality. A more invasive vascular approach, for CoreValve implantation, even in higher risk patients, does not affect early-term, mid-term and long-term outcomes.

  13. Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients.

    Science.gov (United States)

    Strong, Vivian E; Gholami, Sepideh; Shah, Manish A; Tang, Laura H; Janjigian, Yelena Y; Schattner, Mark; Selby, Luke V; Yoon, Sam S; Salo-Mullen, Erin; Stadler, Zsofia K; Kelsen, David; Brennan, Murray F; Coit, Daniel G

    2017-12-01

    The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.

  14. Disaster mental health

    DEFF Research Database (Denmark)

    Henderson, Silja; Berliner, Peter; Elsass, Peter

    2015-01-01

    In this chapter we focus on disaster mental health, particularly theoretical and research-based implications for intervention. The field of disaster mental health research is vast and impossible to cover in a single chapter, but we will visit central research, concepts, and understandings within...... disaster mental health and intervention, and refer to further literature where meaningful. We conclude the chapter with recommendations for further research....

  15. Environmental Disasters and Migration

    OpenAIRE

    Mbaye, Linguère Mously; Zimmermann, Klaus F.

    2015-01-01

    This paper reviews the effect of environmental disasters on migration. Although there is an increase of environmental disasters and migration over the past years, the relationship is complex. While some authors find that environmental disasters increase migration, others show that they have only a marginal or no effect or are even negative. Migration appears to be an insurance mechanism against environmental shocks. Remittances help to decrease households' vulnerability to shocks but also dam...

  16. Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center.

    Science.gov (United States)

    Ness, Thomas; Boehringer, Daniel; Heinzelmann, Sonja

    2017-04-27

    Patients with intermediate uveitis (IU) represent a heterogenous group characterized by a wide spectrum of etiologies and regional differences. Aim of the study was to analyze the characteristics of patients with IU examined in an academic center in Germany. We conducted a retrospective analysis of the clinical records of all patients with intermediate uveitis referred to the Eye Center, University of Freiburg from 2007 to 2014. Diagnosis followed the Standardization in Uveitis Nomenclature (SUN) criteria. Data analysis included: etiology of IU, demographics, complications, treatment and visual acuity. We identified 159 patients with intermediate uveitis during that period. Mean age at diagnosis was 35 years. Most are female (64%), and the mean duration of IU was 6.1 years (range 1 month - 35 years). Etiology of IU was idiopathic in 59%. Multiple sclerosis (MS) (20%) and sarcoidosis (10%) were frequent systemic causes of IU. Other etiologies including infectious diseases (tuberculosis, borreliosis) or immune-mediated conditions (eg, after vaccination) were present in 11%. The pattern of complications included macular edema (CME) (36%), cataract (24%), secondary glaucoma (7%), and epiretinal membrane formation (19%). Periphlebitis and optic neuritis were more frequent in conjunction with MS. Treatment comprised local and systemic steroids, immunosuppressive agents, biologics, and surgery. Best corrected visual acuity was better than 20/25 in 60% of the eyes after more than 10 years of follow-up. In our German academic center, most IU cases were idiopathic or associated with MS or sarcoidosis. In contrast to other countries, infectious cases were rare. Patients' overall visual prognosis is favorable even when the duration of IU has been long and and despite numerous complications.

  17. Patient-centered medical home transformation with payment reform: patient experience outcomes.

    Science.gov (United States)

    Heyworth, Leonie; Bitton, Asaf; Lipsitz, Stuart R; Schilling, Thad; Schiff, Gordon D; Bates, David W; Simon, Steven R

    2014-01-01

    To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform. Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009). We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering. More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.

  18. Outcomes of a Freedom of Choice Reform in Community Mental Health Day Center Services.

    Science.gov (United States)

    Eklund, Mona; Markström, Urban

    2015-11-01

    A freedom-of-choice reform within mental health day center services was evaluated. The reform aimed to (1) facilitate users' change between units and (2) increase the availability of service providers. Seventy-eight users responded to questionnaires about the reform, empowerment, social network, engagement and satisfaction and were followed-up after 15 months. Fifty-four percent knew about the reform. A majority stated the reform meant nothing to them; ~25 % had a negative and ~20 % a positive opinion. Satisfaction with the services had decreased after 15 months. Empowerment decreased for a more intensively followed subgroup. No positive consequences of the reform could thus be discerned.

  19. Disaster mitigation: initial response.

    Science.gov (United States)

    Kennedy, George; Richards, Michael; Chicarelli, Michael; Ernst, Amy; Harrell, Andrew; Stites, Danniel

    2013-01-01

    The objective of this review is to stimulate the reader's considerations for developing community disaster mitigation. Disaster mitigation begins long before impact and is defined as the actions taken by a community to eliminate or minimize the impact of a disaster. The assessment of vulnerabilities, the development of infrastructure, memoranda of understanding, and planning for a sustainable response and recovery are parts of the process. Empowering leadership and citizens with knowledge of available resources through the planning and development of a disaster response can strengthen a community's resilience, which can only add to the viability and quality of life enjoyed by the entire community.

  20. Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III–IV irreducible development dysplasia of the hip??

    Directory of Open Access Journals (Sweden)

    Tzu-Cheng Yang

    2017-12-01

    Conclusion: With regard to both clinical outcomes and complication rates, restoration of the hip center using subtrochanteric osteotomy may provide similar benefits to those patients with proximal placement of the acetabular component in treating Crowe type III–IV DDH.

  1. Collaboration across eight research centers: unanticipated benefits and outcomes for project managers.

    Science.gov (United States)

    Perez, Norma A; Weathers, Benita; Willis, Marilyn; Mendez, Jacqueline

    2013-02-01

    Managers of transdisciplinary collaborative research lack suitable didactic material to support the implementation of research methodologies and to build ongoing partnerships with community representatives and peers, both between and within multiple academic centers. This article will provide insight on the collaborative efforts of project managers involved in multidisciplinary research and their subsequent development of a tool kit for research project managers and/or directors. Project managers from the 8 Centers for Population Health and Health Disparities across the nation participated in monthly teleconferences to share experiences and offer advice on how to achieve high participation rates and maintain community involvement in collaboration with researchers and community leaders to achieve the common goal of decreasing health inequities. In the process, managers recognized and seized the opportunity to produce a tool kit that was designed for future project managers and directors. Project managers in geographically distinct locations maintained a commitment to work together over 4 years and subsequently built upon an existing communications network to design a tool kit that could be disseminated easily to a diverse audience.

  2. Child advocacy center multidisciplinary team decision and its association to child protective services outcomes.

    Science.gov (United States)

    Brink, Farah W; Thackeray, Jonathan D; Bridge, Jeffrey A; Letson, Megan M; Scribano, Philip V

    2015-08-01

    Limited studies exist evaluating the multidisciplinary team (MDT) decision-making process and its outcomes. This study evaluates the MDT determination of the likelihood of child sexual abuse (CSA) and its association to the outcome of the child protective services (CPS) disposition. A retrospective cohort study of CSA patients was conducted. The MDT utilized an a priori Likert rating scale to determine the likelihood of abuse. Subjects were dichotomized into high versus low/intermediate likelihood of CSA as determined by the MDT. Clinical and demographic characteristics were compared based upon MDT and CPS decisions. Fourteen hundred twenty-two patients were identified. A high likelihood for abuse was determined in 997 cases (70%). CPS substantiated or indicated the allegation of CSA in 789 cases (79%, Kappa 0.54). Any CSA disclosure, particularly moderate risk disclosure (AOR 59.3, 95% CI 26.50-132.80) or increasing total number of CSA disclosures (AOR 1.3, 95% CI 1.11-1.57), was independently associated with a high likelihood for abuse determination. Specific clinical features associated with discordant cases in which MDT determined high likelihood for abuse and CPS did not substantiate or indicate CSA included being white or providing a low risk CSA disclosure or other non-CSA disclosure. MDT determination regarding likelihood of abuse demonstrated moderate agreement to CPS disposition outcome. CSA disclosure is predictive of the MDT determination for high likelihood of CSA. Agreement between MDT determination and CPS protection decisions appear to be driven by the type of disclosures, highlighting the importance of the forensic interview in ensuring appropriate child protection plans. Published by Elsevier Ltd.

  3. The effect of helmets on motorcycle outcomes in a level I trauma center in Connecticut.

    Science.gov (United States)

    Wiznia, Daniel H; Kim, Chang-Yeon; Dai, Feng; Goel, Alex; Leslie, Michael P

    2016-08-17

    The State of Connecticut has a partial motorcycle helmet law, which has been linked to one of the lowest helmet compliance rates in the Northeast. We examine the clinical and financial impact of low motorcycle helmet use in the State of Connecticut. A retrospective cohort study comparing the outcomes between helmeted and nonhelmeted motorcycle crash victims over a 12.5-year period, from July 2, 2002, to December 31, 2013. All patients who were admitted to the hospital after a motorcycle crash were included in the study. Patients were stratified into helmeted and nonhelmeted cohorts. Group differences were compared using t-test or Wilcoxon rank test for continuous variables and chi-square test for dichotomous outcomes. Regression models were created to evaluate predictors of helmet use, alcohol and drugs as confounding variables, and factors that influenced hospital costs. The registry included 986 eligible patients. Of this group, 335 (34%) were helmeted and 651 (66%) were nonhelmeted. Overall, nonhelmeted patients had a worse clinical presentation, with lower Glasgow Coma Scale (GCS; P helmeted patients incurred $14,970 (P =.18). ISS, GCS, and ICU length of stay were significantly correlated with increased hospital costs (P helmet was a significant predictor of mortality (P =.04) after adjusting for alcohol/drug use and age. Helmet use is associated with lower injury severity and increased survival after a motorcycle crash. These outcomes remained consistent even after controlling for age and alcohol and drug use. The medical and financial impact of Connecticut's partial helmet law should be carefully evaluated to petition for increased education and enforcement of helmet use.

  4. Complex gastroschisis: Clinical spectrum and neonatal outcomes at a referral center.

    Science.gov (United States)

    Laje, Pablo; Fraga, Maria V; Peranteau, William H; Hedrick, Holly L; Khalek, Nahla; Gebb, Juliana S; Moldenhauer, Julie S; Johnson, Mark P; Flake, Alan W; Adzick, N Scott

    2018-03-14

    To evaluate the outcomes of neonates with complex gastroschisis (GC), and correlate outcomes with each type of complication. Retrospective review of patients with complex GC owing to prenatal and/or postnatal abdominal complications; 2008-2016. Primary outcomes: time to discontinue parenteral nutrition (off-PN), length of stay (LOS) and neonatal survival. We treated 58 patients with complex gastroschisis owing to abdominal complications, which were: intestinal necrosis at birth (n=9), intestinal atresia (n=16), medical necrotizing enterocolitis (NEC) (n=15), surgical NEC (n=1), in utero volvulus (n=1), vanishing gastroschisis (n=2), severe intestinal dysmotility (n=1), delayed abdominal closure (n=3), abdominal compartment syndrome (n=2) and hiatal hernia/severe gastroesophageal reflux disease (GERD; n=11). The off-PN time and LOS of the whole group were 92 (35-255) and 119 (42-282) days, significantly longer than those of a demographically equivalent contemporaneous series of 125 patients with uncomplicated gastroschisis (off-PN 32 [12-105] days [pintestinal necrosis at birth or with intestinal atresia had the longest off-PN and LOS times (133 [38-255] / 157 [43-282] and 114 [36-222] / 143 [42-262] days, respectively), followed by patients with complications of the abdominal wall closure (n=5) (69 [43-93] / 89 [58-110] days), patients with hiatal hernias/severe GERD who required fundoplication (63 [35-84] / 89 [57-123] days) and patients who developed medical NEC (67 [35-103] / 76 [50-113] days). Short-bowel syndrome/PN-dependence occurred in 6/58 (10%) patients (2 vanishing gastroschisis, 1 in utero volvulus, 2 intestinal atresias and 1 bowel necrosis at birth). There were no neonatal mortalities. Gastroschisis can be complicated by a wide variety of prenatal and postnatal events. The most severe outcomes occur in patients with bowel necrosis at birth, intestinal atresias, or vanishing gastroschisis. Complications, however, did not affect neonatal survival in our

  5. Clinical outcomes of a novel, family-centered partial hospitalization program for young patients with eating disorders.

    Science.gov (United States)

    Ornstein, R M; Lane-Loney, S E; Hollenbeak, C S

    2012-09-01

    Eating disorders (ED) in children and younger adolescents are becoming more evident, but there is a small evidence base for their management in this population. We hypothesized that a new family-centered partial hospital program for young patients would be effective in promoting weight gain, as well as improvement in psychiatric symptoms. A retrospective chart review of 56 patients treated in the program between August 2008 and November 2009 was performed. Historical data, anthropometric variables and scores from psychological instruments [Children's Eating Attitudes Test (ChEAT), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS)] were collected on admission and at discharge. After exclusion, 30 patients were available for statistical analysis, using paired t-tests. The primary outcome variables were improvement in weight and change in total ChEAT score. Secondary outcomes included improvements in the CDI and RCMAS scores. Multivariate analysis included linear regression models that controlled for patient-specific fixed effects. The cohort was 87% female with a mean age of 12.8±2 years; 60% were diagnosed with ED not otherwise specified. Two-thirds had a co-morbid depressive and/or anxiety disorder. Change in weight was significant (pfamily-centered partial hospital program had significant improvements in weight and psychological parameters. This approach holds significant promise for the management of young ED patients.

  6. Prediction of breast biopsy outcome using a likelihood ratio classifier and biopsy cases from two medical centers

    Science.gov (United States)

    Bilska-Wolak, Anna O.; Floyd, Carey E., Jr.; Lo, Joseph Y.

    2003-05-01

    Potential malignancy of a mammographic lesion can be assessed using the mathematically optimal likelihood ratio (LR) from signal detection theory. We developed a LR classifier for prediction of breast biopsy outcome of mammographic masses from BI-RADS findings. We used cases from Duke University Medical Center (645 total, 232 malignant) and University of Pennsylvania (496, 200). The LR was trained and tested alternatively on both subsets. Leave-one-out sampling was used when training and testing was performed on the same data set. When tested on the Duke set, the LR achieved a Received Operating Characteristic (ROC) area of 0.91+/- 0.01, regardless of whether Duke or Pennsylvania set was used for training. The LR achieved a ROC area of 0.85+/- 0.02 for the Pennsylvania set, again regardless of which set was used for training. When using actual case data for training, the LR's procedure is equivalent to case-based reasoning, and can explain the classifier's decisions in terms of similarity to other cases. These preliminary results suggest that the LR is a robust classifier for prediction of biopsy outcome using biopsy cases from different medical centers.

  7. Risk Factors and Consequent Outcomes of Placenta Previa: Report From a Referral Center

    Directory of Open Access Journals (Sweden)

    Soraya Saleh Gargari

    2016-12-01

    Full Text Available  Because of an unknown factor, the frequency of complicated pregnancy with placenta previa has been raised during past decade. This study was designed to deepen our understanding of risk factors and outcomes of placenta previa in our country. This study investigated 694 cases of placenta previa comparing with 600 healthy pregnant women with not overlie placenta in two referral and tertiary Obstetrics and Gynecological Hospital in Iran on the basis of the clinical and para-clinical analysis, in order to find the probable risk factors for occurrence of placenta previa and its effect on maternal and neonatal complications. The most important risk factor for the occurrence of placenta previa was advanced maternal age (P<0.001 and history of stillbirth (OR=117.2, CI=58.3-236.0. In the other hand, the most substantial outcome of this disorder was a reduction of gestational age (P<0.001 and low birth weight neonatally (P<0.001. The conservative follow-up should be programmed for women with placenta previa based on the type of risk factors which can provide the best possible management to decrease the morbidity and mortality of their related complications.

  8. Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Chia-shi Wang

    2017-01-01

    Full Text Available There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS. We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71% of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8 days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

  9. Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

    Science.gov (United States)

    Bagheri, Abbas; Salour, Hossein; Aletaha, Maryam; Yazdani, Shahin

    2012-01-01

    Purpose To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. Methods In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. Results Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. Conclusions Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed. PMID:22323877

  10. Incidence, Etiology, and Outcomes of Rhabdomyolysis in a Single Tertiary Referral Center

    Science.gov (United States)

    Park, Jae-Seok; Seo, Min-Sook; Gil, Hyo-Wook; Yang, Jong-Oh; Lee, Eun-Young

    2013-01-01

    We have encountered numerous cases of rhabdomyolysis associated with acute pesticide intoxication; however, the cause, incidence, and treatment outcomes of rhabdomyolysis have not been studied. The current study involved 2,125 patients hospitalized with acute chemical poisoning. Based on clinical and laboratory parameters and treatment outcomes, we found that overall incidence of rhabdomyolysis in our hospital was 0.06% (93 of 143,830 patients admitted), but the incidence associated with acute pesticide intoxication was 1.8% (33 of 1,793 cases). The incidence of rhabdomyolysis after pesticide intoxication was significantly higher in men than in women (P = 0.010). The amount of pesticide ingested was significantly higher in rhabdomyolysis patients than that in those who did not develop rhabdomyolysis (mean ± SD, 114.1 ± 79.5 mL vs 74.1 ± 94.2 mL, P = 0.010). Our results show that pesticide intoxication is a frequent cause of rhabdomyolysis and is more common among men than women. The volume of pesticide ingested, and not the degree of human toxicity, is the main factor influencing the incidence of rhabdomyolysis. PMID:23960447

  11. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael B.; Dappa, Evelyn; Jungmann, Florian; Kloeckner, Roman; Schotten, Sebastian; Wirth, Gesine M.; Mildenberger, Peter; Kreitner, Karl-Friedrich; Oberholzer, Katja; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Mittler, Jens; Lang, Hauke [University Hospital of Mainz, Department of Abdominal, Visceral and Transplantation Surgery, Mainz (Germany)

    2015-07-15

    To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. (orig.)

  12. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.

    Science.gov (United States)

    Chaudhry, Imtiaz A; Shamsi, Farrukh A; Elzaridi, Elsanusi; Al-Rashed, Waleed; Al-Amri, Abdulrahman; Al-Anezi, Fahad; Arat, Yonca O; Holck, David E

    2007-02-01

    To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East. Noncomparative, interventional, retrospective case series. Patients diagnosed with orbital cellulitis. A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study. Patient demographics, factors predisposing to orbital cellulitis, and resulting complications. A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days

  13. Preparing Nursing Students for Leadership Using a Disaster-Related Simulation.

    Science.gov (United States)

    Smith, Sherrill; Farra, Sharon; Dempsey, Anita; Arms, Deborah

    2015-01-01

    Increasing numbers and severity of disasters across the globe require nurses to be prepared to provide leadership in disaster situations. To address this need, a combination of didactic and simulation exercises was used to provide a daylong experience emphasizing application of nursing leadership skills in disasters to senior baccalaureate students. Evaluation of learning outcomes demonstrated significant improvement in student self-efficacy related to leadership in disasters.

  14. 77 FR 58902 - Louisiana Disaster #LA-00048

    Science.gov (United States)

    2012-09-24

    .... Incident: Hurricane Isaac. Incident Period: 08/26/2012 through 09/10/2012. DATES: Effective Date: 09/14... And Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  15. Patterns of Utilization of Adjuvant Radiotherapy and Outcomes in Black Women After Breast Conservation at a Large Multidisciplinary Cancer Center

    International Nuclear Information System (INIS)

    Edwards-Bennett, Sophia M.; Jacks, Lindsay M.; McCormick, Beryl; Zhang, Zhigang; Azu, Michelle; Ho, Alice; Powell, Simon; Brown, Carol

    2011-01-01

    Purpose: Population-based studies have reported that as many of 35% of black women do not undergo radiotherapy (RT) after breast conservation surgery (BCS). The objective of the present study was to determine whether this trend persisted at a large multidisciplinary cancer center, and to identify the factors that predict for noncompliance with RT and determine the outcomes for this subset of patients. Methods and Materials: Between January 2002 and December 2007, 83 black women underwent BCS at Memorial Sloan-Kettering Cancer Center and were therefore eligible for the present study. Of the 83 women, 38 (46%) had Stage I, 38 (46%) Stage II, and 7 (8%) Stage III disease. Of the study cohort, 31 (37%) had triple hormone receptor-negative tumors. RT was recommended for 81 (98%) of the 83 patients (median dose, 60 Gy). Results: Of the 81 women, 12 (15%) did not receive the recommended adjuvant breast RT. Nonreceipt of chemotherapy (p = .003) and older age (p = .009) were associated with nonreceipt of RT. With a median follow-up of 70 months, the 3-year local control, locoregional control, recurrence-free survival, disease-free survival, and overall survival rate was 99% (actuarial 5-year rate, 97%), 96% (actuarial 5-year rate, 93%), 95% (actuarial 5-year rate, 92%), 92% (actuarial 5-year rate, 89%), and 95% (actuarial 5-year rate, 91%), respectively. Conclusion: We found a greater rate of utilization adjuvant breast RT (85%) among black women after BCS than has been reported in recent studies, indicating that excellent outcomes are attainable for black women after BCS when care is administered in a multidisciplinary cancer center.

  16. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  17. Clinical spectrum and outcomes of crescentic glomerulonephritis: A single center experience

    Directory of Open Access Journals (Sweden)

    S K Rampelli

    2016-01-01

    Full Text Available There is limited data on the etiology, clinical and histopathological spectrum and outcomes of crescentic glomerulonephritis (CrGN in adult Indian population. This prospective study was done to evaluate the etiology, clinicohistological patterns and predictors of outcome of CrGN in South Indian population. All the patients received standard protocol based immunosuppression in addition to supportive care. Immune-complex glomerulonephritis (ICGN was the most common etiology (n = 31; 77.5% followed by pauci-immune glomerulonephritis (PauciGN; n = 8; 20% and anti-glomerular basement membrane disease (n = 1; 2.5%. The most common etiology of ICGN was IgA nephropathy (n = 11; 27.5% followed by lupus nephritis (n = 7; 17.5% and post-infectious glomerulonephritis (PIGN (n = 7; 17.5%. The patients with PauciGN were significantly older compared to those with ICGN (44.5 ± 15 years vs. 31.8 ± 11 years; P = 0.01. The patients with PauciGN presented with significantly higher serum creatinine (9.7 ± 4.4 vs. 6.6 ± 3.3 mg/dl; P = 0.03. The histopathologic parameters of ICGN and PauciGN were comparable except for a higher proportion of sclerosed glomeruli in ICGN. At the end of 3 months follow-up, only two patients went into complete remission (5.4%. Majority of the patients had end-stage renal failure (48.6% and were dialysis dependent and seven patients (18.9% expired. There was no signifi difference in the renal survival (10.9 ± 1.9 vs. 9.6 ± 3.3 months or patient survival (17.5 ± 2.1 vs. 17.3 ± 4.3 months. The parameters associated with adverse outcomes at 3 months were hypertension (odds ratio [OR]: 0.58; confidence interval [CI]: 0.36–0.94, need for renal replacement therapy (OR: 0.19; CI: 0.04–0.9, serum creatinine at admission (P = 0.019, estimated glomerular filtration rate (P = 0.022 and percentage of fibrocellular crescents (P = 0.022.

  18. The Role of Family Characteristics for Students' Academic Outcomes: A Person-Centered Approach.

    Science.gov (United States)

    Häfner, Isabelle; Flunger, Barbara; Dicke, Anna-Lena; Gaspard, Hanna; Brisson, Brigitte M; Nagengast, Benjamin; Trautwein, Ulrich

    2017-04-17

    Using data from 1,571 ninth-grade students (M age  = 14.62) from 82 academic track schools in Germany and their predominantly Caucasian middle-class parents, configurations of different family characteristics reported by parents were investigated. Latent profile analyses considering academic involvement, family interest, parents' self-concept, child's need for support, and parents' time and energy identified average, indifferent, motivated and engaged, motivated and disengaged, and involved families. Cross-sectional and longitudinal associations with students' motivational (self-concept, effort, and interest) and achievement outcomes (achievement test and grades) in math were analyzed. Students from families classified as motivated and disengaged showed higher initial levels motivation and achievement. Over 5 months, these students also showed an increase in self-concept and higher achievement than students from other family types. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.

  19. Risk Factors and Consequent Outcomes of Placenta Previa: Report From a Referral Center.

    Science.gov (United States)

    Saleh Gargari, Soraya; Seify, Zahra; Haghighi, Ladan; Khoshnood Shariati, Maryam; Mirzamoradi, Masoumeh

    2016-11-01

     Because of an unknown factor, the frequency of complicated pregnancy with placenta previa has been raised during past decade. This study was designed to deepen our understanding of risk factors and outcomes of placenta previa in our country. This study investigated 694 cases of placenta previa comparing with 600 healthy pregnant women with not overlie placenta in two referral and tertiary Obstetrics and Gynecological Hospital in Iran on the basis of the clinical and para-clinical analysis, in order to find the probable risk factors for occurrence of placenta previa and its effect on maternal and neonatal complications. The most important risk factor for the occurrence of placenta previa was advanced maternal age (Pplacenta previa based on the type of risk factors which can provide the best possible management to decrease the morbidity and mortality of their related complications.

  20. PM 2.5 exposure assessment of the population in Lower Manhattan area of New York City after the World Trade Center disaster

    Science.gov (United States)

    Ng, S. P.; Dimitroulopoulou, C.; Grossinho, A.; Chen, L. C.; Kendall, M.

    On 11 September 2001, the explosion and the collapse of the World Trade Center (WTC) Twin Towers in New York City (NYC), USA, generated a massive release of dust and inhalable toxic substances to the atmosphere as a result of the pulverization of various building materials, furniture, and computers. Many concerns were raised as Particulate Matter (PM) levels in Lower Manhattan might not meet the current National Ambient Air Quality Standards (NAAQS) (65 μg m -3). The current study aims to provide a first estimate of the scale of population exposures during this episode. Data collected from existing monitoring stations in September showed the occurrence of a series of high peaks of PM 2.5 registered in the Lower Manhattan area after the 11 September. An interpolation technique was used within a Geographical Information Systems (GIS) environment to estimate outdoor PM 2.5 concentrations over NYC. Monthly average of 24 h outdoor PM 2.5 concentration of Lower Manhattan was 20.2 μg m -3 and did not exceed the NAAQS value. PM 2.5 concentrations in indoor micro-environments were simulated by a deterministic micro-environmental model (INTAIR) and linear regression equations. Three typical population groups were identified for the NYC area—home-makers, office/shop-workers, and students/children—and their 12 h nighttime and daytime exposures were estimated from 14 September until the end of September, either as mean exposure (daytime and nighttime) or as exposure weighted by residential population distribution (nighttime only). Average nighttime and daytime exposures of the Lower Manhattan population were calculated to be 37.3 and 23.6 μg m -3, respectively (daily average: 30.45 μg m -3), in which the various group movements and activities, smoking habits of individuals, and special population movements due to access restrictions and risk avoidance behaviors were considered. Within the study period, assuming the real nighttime population distribution followed the

  1. Outcomes of kidney transplant tourism in children: a single center experience.

    Science.gov (United States)

    Majid, Abdul; Al Khalidi, Lina; Ahmed, Bushra Q; Opelz, Gerhard; Schaefer, Franz

    2010-01-01

    Transplant tourism is a necessity for children with end-stage renal disease living in regions without established local transplantation programs. The use of kidneys from living unrelated donors (LURDs) was common practice in Asia prior to the recent global condemnation of commercial organ transplantation. Objective information on the outcomes of pediatric transplant tourism is scarce. Here, we report the Dubai experience with 45 renal allograft transplantations performed outside the United Arab Emirates (UAE) between 1993 and 2009. Transplantation from 33 LURDs, ten living related donors (LRDs) and two deceased donors was performed in 14 different countries. The mean number of human leukocyte antigen (HLA) A/B/DR allele matches was 1.4 +/- 0.8 in the LURD graft recipients and 3.9 +/- 0.7 in the LRD recipients. Outcomes were compared with those of a matched group of 3,150 pediatric LRD transplantations from the Collaborative Transplant Study (CTS). Ten-year patient survival was 100% in the LRD patients, 91.2% in the LURD patients, and 92% in the CTS patients. The three deaths in the LURD group occurred within the first 4 months after transplantation and were related to acute rejection. One-year and 10-year graft survival was 100% in the LRD group and 94.8% and 66.7% in the CTS-LRD groups, vs 87.8% and 43.4% in the LURD group. Major viral infections [Epstein-Barr virus (EBV), cytomegalovirus (CMV), varicella zoster (VZV)] were four-times more common in patients that had received LURD grafts than in those that had received LRD grafts. In conclusion, whereas LRD kidney transplantation performed abroad yields excellent long-term results, transplantation of LURD kidneys is fraught with a high complication rate affecting graft and even early patient survival.

  2. Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study.

    Science.gov (United States)

    Sahakyan, Mushegh A; Røsok, Bård Ingvald; Kazaryan, Airazat M; Barkhatov, Leonid; Lai, Xiaoran; Kleive, Dyre; Ignjatovic, Dejan; Labori, Knut Jørgen; Edwin, Bjørn

    2016-11-01

    Obesity is known as a risk factor for intra- and postoperative complications in pancreatic operation. However, the operative outcomes in obese patients undergoing laparoscopic distal pancreatectomy remain unclear. A total number of 423 patients underwent laparoscopic distal pancreatectomy at Oslo University Hospital-Rikshospitalet from April 1997 to December 2015. Patients were categorized into 3 groups based on the body mass index: normal weight (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), and obese (≥30 kg/m 2 ). After excluding underweight patients, 402 patients were enrolled in this study. Obese patients had significantly longer operative time and increased blood loss compared with overweight and normal weight patients (190 [61-480] minutes vs 158 [56-520] minutes vs 153 [29-374] minutes, P = .009 and 200 [0-2,800] mL vs 50 [0-6250] mL vs 90 [0-2,000] mL, P = .01, respectively). A multiple linear regression analysis identified obesity as predictive of prolonged operative time and increased blood loss during laparoscopic distal pancreatectomy. The rates of clinically relevant pancreatic fistula and severe complications (≥grade III by Accordion classification) were comparable in the 3 groups (P = .23 and P = .37, respectively). A multivariate logistic regression model did not demonstrate an association between obesity and postoperative morbidity (P = .09). The duration of hospital stay was comparable in the 3 groups (P = .13). In spite of longer operative time and greater blood loss, laparoscopic distal pancreatectomy in obese patients is associated with satisfactory postoperative outcomes, similar to those in normal weight and overweight patients. Hence, laparoscopic distal pancreatectomy should be equally considered both in obese and nonobese patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Wound management and outcome of 595 electrical burns in a major burn center.

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    Li, Haisheng; Tan, Jianglin; Zhou, Junyi; Yuan, Zhiqiang; Zhang, Jiaping; Peng, Yizhi; Wu, Jun; Luo, Gaoxing

    2017-06-15

    Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Clinical practice and outcomes in advanced gastrointestinal stromal tumor: Experience from an Indian tertiary care center

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    Subhadeep Bose

    2017-01-01

    Full Text Available Background: Management of advanced Gastrointestinal stromal tumors (GIST has been revolutionized with the use of Imatinib guided by mutation analysis. Data from India remains scarce. Materials and Methods: Patients with metastatic GIST who were treated at Department of Gastro-intestinal & Hepaticopancreaticobiliary Oncology Unit at Tata Memorial Hospital, Mumbai between December, 2004 and December 2015 were included in the analysis. Clinical and radiological data was retrieved from stored medical records and charts. Results: A total of 83 patients with metastatic GIST were available for analysis. Median age was 54 years with a 3:1 male predominance. Stomach was the most common site of primary with liver being the most common site of metastasis. c-Kit mutation analysis results were available for 44 patients with exon 11 mutant being the most common mutation. With a median follow up of 33 months, the 10 years estimated progression free and overall survival (OS was 18% and 51% respectively. Overall response rate to first line imatinib was 37.6% and estimated 3 years OS to first line therapy was significantly better for Exon 11 mutated patients (p=0.016. 34 patients received second line therapy in the form of either sunitinib, pazopanib or increased dose imatinib with a clinical benefit rate of 73.5%. C-Kit mutated patients had a better median OS compared to non mutated patients. Conclusions: GIST diagnosed and treated in the Indian subcontinent appears to show improved outcomes. The importance of c-Kit mutation analysis in determining the prognosis and outcomes of patients with advanced GIST is emphasized.

  5. Outcomes of thymoma treated with multimodality approach: a tertiary cancer center experience of 71 patients.

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    Julka, Pramod K; Sharma, Daya N; Mallick, Supriya; Gandhi, Ajeet K; Joshi, Nikhil P; Haresh, Kunhi P; Gupta, Subhash; Rath, Goura K

    2017-11-23

    To explore the demographics and clinical outcome of patients with thymoma treated with a multimodality approach at our institute. A total of 71 patients with thymoma (Masaoka stage II-IV and WHO subtype AB-B3) treated from 1999-2013 were included in this retrospective analysis. Age, stage, WHO subtypes, details of surgery, radiotherapy, and chemotherapy were noted. Progression-free survival (PFS) was estimated using Kaplan-Meier method and SPSS (version 21.0) was used for statistical analysis. Male:female ratio was 56:15 with median age at presentation of 41 years. Stage-wise distribution was 6:46:19 for stage II, stage III, and stage IV, respectively. A total of 31 patients (44%) had associated myasthenia gravis and 3 had pure red cell aplasia. A total of 57 patients (80%) underwent radical thymectomy and all of these patients received adjuvant radiotherapy. A total of 15 patients and 7 patients received adjuvant chemotherapy and neoadjuvant chemotherapy, respectively. At median follow-up of 19.3 months (range 7.9-72.3 months), 2-year and 3-year PFS rate for the entire cohort was 78.3% and 57.1%, respectively. On univariate analysis, surgery (hazard ratio [HR] 3.881; 95% confidence interval [CI] 1.784-19.220; p = 0.006) and stage (HR 5.457; 95% CI 1.567-18.996; p = 0.0001) were significant prognostic factors and association with myasthenia gravis (HR 0.404; 95% CI 0.151-1.078; p = 0.078) trended towards better PFS. Stage retained its prognostic significance (HR 5.501; 95% CI 2.076-14.573; p = 0.0006) on multivariate analysis. Multimodality management of locally advanced thymoma yields decent survival outcomes. Masaoka stage is an independent prognostic factor for survival and radical surgery should be contemplated in all cases of locoregionally limited thymoma.

  6. Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident

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    Ming-Ju Tsai

    2013-01-01

    Full Text Available Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU, the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1. Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1 and those with two senior residents (p > 0.2. Although the weaning rate in the RCC gradually improved over time (p  0.7. Thus, we concluded that in a well-organized setting, the levels (experiences of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork

  7. The Impact of Natural Disasters on Youth: A Focus on Emerging Research beyond Internalizing Disorders.

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    Self-Brown, Shannon; Lai, Betty; Patterson, Alexandria; Glasheen, Theresa

    2017-08-01

    This paper reviews youth outcomes following exposure to natural disaster, with a focus on three relatively understudied outcomes: externalizing behavior problems, physical health, and posttraumatic growth. Recent, high-impact studies focusing on each outcome are summarized. Studies highlighted in this review utilize innovative and comprehensive approaches to improve our current understanding of youth broad-based physical and mental health outcomes beyond PTSD. The review concludes with recommendations to advance the field of youth disaster research by exploring how disasters may impact children across multiple domains, as well as using cutting edge ecobiological approaches and advanced modeling strategies to better understand how youth adjust and thrive following natural disaster.

  8. [Characteristics and treatment outcomes in 822 adult patients with acute myeloid leukemia:a single center experience].

    Science.gov (United States)

    Lin, Dong; Zhou, Chunlin; Wei, Hui; Liu, Bingcheng; Wang, Ying; Liu, Kaiqi; Li, Wei; Gong, Benfa; Wang, Jinyu; Wei, Shuning; Zhang, Guangji; Zhao, Xingli; Li, Yan; Liu, Yuntao; Gong, Xiaoyuan; Sun, Mingyuan; Lu, Yuan; Mi, Yingchang; Wang, Jianxiang

    2014-12-01

    To investigate the characteristics and the short- or long-term treatment outcomes of the adult patients with acute myeloid leukemia (AML) in China. From 1999 to 2010, 822 adult cases with AML were enrolled, diagnosed and classified by the FAB and WHO criteria, respectively. The treatment outcomes and prognostic factors were analyzed retrospectively. In all patients with a median age of 38.5(15-83) years, acute monoblastic and monocytic leukemia (M5), AML with t(15;17)/PML-RARα (APL) and AML with t(8;21)/AML1-ETO(M2b) were the most common subtypes, accounting for 29.7%, 20.9% and 14.6% respectively. In APL patients, CR was achieved in 95.2%, with an early death (ED) rate of 4.8%. And the estimated overall survival (OS) and disease-free survival (DFS) at 5 year was 87.5% and 88.8%, respectively. Patients with other AML subtype (Non-APL) revealed a CR rate of 82.0%, ED of 4.3%, and estimated 5-year OS and DFS both of 48.8%. The OS rate of Non-APL patients at 3-year varied significantly (Pleukemia centers. Chemotherapy by risk stratification, after diagnosis and classification according to the WHO criteria, is a key point to improve the outcomes in AML.

  9. Maggot Debridement Therapy in Disaster Medicine.

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    Stadler, Frank; Shaban, Ramon Z; Tatham, Peter

    2016-02-01

    When disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as amputations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster. This report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and amputations in case of life-threatening wound infection. There are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management

  10. Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center.

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    Klaassen, Zachary; Go, Pauline H; Mansour, E Hani; Marano, Michael A; Petrone, Sylvia J; Houng, Abraham P; Chamberlain, Ronald S

    2011-08-01

    Burns involving the genitalia and perineum are commonly seen in the context of extensive total body surface area (TBSA) burns and rarely as isolated injuries because of protection provided by the thighs and the abdomen. Genital burns usually result in extended hospital stays and are accompanied by severe morbidity and increased mortality. A retrospective analysis of consecutive pediatric (burns involving the genitalia admitted to the Saint Barnabas Medical Center Level 1 Burn Unit from January 1, 1995, to December 31, 2009, was performed. One hundred sixty pediatric patients (8.3%) had a genital burn, including 105 patients younger than 5 years (65.6%) and 55 patients between 5 and 18 years (34.4%). Overall mean TBSA was 13.8% ± 16.8%, mean TBSA (genitalia) was 0.84% ± 0.25%, mean length of stay (LOS) was 11.9 ± 11.9 days, and mean burn intensive care unit LOS was 4.9 ± 9.7 days. In patients younger than 5 years, a TBSA burn more than 10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (2 weeks). Patients 5 years or older are more often male and usually have a TBSA burn more than 15%. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal

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    Bajracharya L

    2015-12-01

    Full Text Available Leena Bajracharya, Reeta Gurung Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal Background: Corneal ulcer is an important cause of blindness in developing countries. Therapeutic keratoplasty for infective keratitis is a frequently performed surgery in these countries.Objective: To find out the outcome of therapeutic keratoplasty for infective keratitis.Methods: Records of 5 years were reviewed of patients who underwent therapeutic keratoplasty from 2006 to 2010. Data collected included demographic parameters, indications for surgery, microbiology of the ulcers, type of surgery performed, and donor tissue details. In the follow-up period, ocular status was evaluated in terms of eradication of disease, anatomic success, graft clarity, visual acuity, and development of glaucoma and cataract.Results: In all, 180 eyes of 180 patients were enrolled in the study; 59.4% of the patients were male. Average age was 44.4±16.7 years. Overall, 71% of infective keratitis was perforated. A total of 101 (56% eyes were positive for organisms of which 49 showed pure fungus and 49 showed pure bacteria. The commonest fungus and bacteria isolated were Aspergillus and Streptococcus, respectively. Average follow-up period was 29±23 months. Overall cure rate of infection was 88.8%, anatomical success rate was 89.5%, and graft clarity was 37.2%. Overall, 43.4% had secondary glaucoma. In the postoperative course, 65.8% of phakic eyes had developed cataract. In all, 38.6% of graft had endothelial failure and 24% of the graft failed due to late infective keratitis. Overall functional success with a visual acuity above 6/60 was 25.4%. Bacterial keratitis had a significantly higher cure rate, anatomical success, and graft clarity compared to fungal keratitis.Conclusion: Therapeutic keratoplasty is an important procedure to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma

  12. Administrative outcomes five years after opening an acute palliative care unit at a comprehensive cancer center.

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    Bryson, John; Coe, Gary; Swami, Nadia; Murphy-Kane, Patricia; Seccareccia, Dori; Le, Lisa W; Rodin, Gary; Zimmermann, Camilla

    2010-05-01

    We examined administrative outcomes after opening an oncology acute palliative care unit (APCU), to determine attainment of administrative targets related to the unit's function of acute palliation. We retrospectively reviewed the administrative database for our APCU for the 5 years following its opening in 2003. Data were abstracted on demographic information, as well as source of admission, primary reason for admission, discharge destination, inpatient death rate, and length of stay. Linear regression and the Cochran-Armitage trend test were used for analysis. In keeping with targets set at the unit's opening, our primary hypotheses were that outpatient admissions, admissions for symptom control, and discharges home would increase over the study period; secondary hypotheses were that length of stay and inpatient death rate would decrease. There were 1748 admissions during the study period: the median age was 64, 54% were women, and the most common cancer sites were gastrointestinal (24%), lung (20%), and gynecologic (13%). There were significant changes for all primary endpoints: outpatient admissions increased from 47% to 70% (p administrative targets for an APCU is possible with appropriate admission criteria, adequate community resources, and education of patients, families and health professionals regarding the model of care.

  13. A multilevel approach to family-centered prevention in schools: process and outcome.

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    Dishion, T J; Kavanagh, K

    2000-01-01

    The Adolescent Transitions Program (ATP) is a multilevel approach to family-based interventions within a middle-school setting. The intervention strategy is based on an ecological framework for studying social and emotional development in children and adolescents, emphasizing a network of contextual factors within which parenting is both directly and indirectly influential on the development of problem behavior. The ATP model includes a universal, selected, and indicated strategy for serving families with young adolescents. The model is designed to address the needs of families of young adolescents that present with a range of problem behavior and diverse developmental histories. The three interventions levels are described, and outcome data are presented, that support the effectiveness of the ATP model. This approach and the associated data are consistent with a broad literature supporting the effectiveness of family interventions, especially for high-risk youth. The effective implementation of family interventions within a school context suggests that these interventions can make a significant contribution to reducing problem behavior and substance use from a public health perspective.

  14. Clinical characteristics and outcomes of acquired hemophilia A: experience at a single center in Japan.

    Science.gov (United States)

    Ogawa, Yoshiyuki; Yanagisawa, Kunio; Uchiumi, Hideki; Ishizaki, Takuma; Mitsui, Takeki; Gouda, Fumito; Ieko, Masahiro; Ichinose, Akitada; Nojima, Yoshihisa; Handa, Hiroshi

    2017-07-01

    Acquired hemophilia A (AHA), which is caused by autoantibodies against coagulation factor VIII (FVIII) is a rare, life-threatening bleeding disorder, the incidence of which appears to be increasing in Japan as the population ages. However, the clinical characteristics, treatment, and outcomes of AHA remain difficult to establish due to the rarity of this disease. We retrospectively analyzed data from 25 patients (median age 73 years; range 24-92 years; male n = 15) diagnosed with AHA between 1999 and 2015 at Gunma University Hospital. We identified autoimmune diseases and malignancy as underlying conditions in four and three patients, respectively. Factor VIII activity was significantly decreased in all patients (median 2.0%; range <1.0-8.0) by FVIII inhibitor (median 47.0 BU/mL; range 2.0-1010). Among 71 bleeding events, subcutaneous or intramuscular hemorrhage was the most prevalent. Seventeen patients required bypassing agents. Twenty-two (91.7%) of 24 patients treated with immunosuppressive agents achieved complete response (CR) during a median of 57.5 days (range 19-714 days). Although three patients (12%) relapsed and seven (28%) died of infection, none of the deaths were related to bleeding. Although most of our patients achieved CR after immunosuppressive therapy, the rate of infection-related mortality was unsatisfactorily high.

  15. Retrospective Analysis of Outcome of Patients with Metastatic Leiomyosarcoma in a Tertiary Referral Center.

    Science.gov (United States)

    van Cann, Tom; Cornillie, Jasmien; Wozniak, Agnieszka; Debiec-Rychter, Maria; Sciot, Raf; Hompes, Daphne; Vergote, Ignace; Schöffski, Patrick

    2018-01-01

    Leiomyosarcoma is a common subtype of soft tissue sarcoma originating from smooth muscle. We evaluated the clinical course and treatment outcome of patients with metastatic leiomyosarcoma. We retrospectively reviewed the records of patients at the University Hospitals Leuven. We identified 122 patients with metastatic leiomyosarcoma, 77 female, median age 59.5 years. Most patients developed leiomyosarcoma in the extremities (35%), the uterus (20%) or the abdomen (19%); 69% developed metachronous metastasis, 31% had synchronous metastatic disease. Most patients (74%) received palliative systemic therapy. The most common first-line treatments were doxorubicin (n = 47) and an anthracycline combined with an alkylator (n = 28). The objective response rate to first-line palliative systemic therapy was 20% and the median progression-free survival was 4.9 months (range 0.1-17.1). The median survival from diagnosis of metastasis was 20.5 months (range 0.4-126.9). On multivariate analysis, metachronous disease, no progressive disease as best response to first-line treatment, the possibility of metastasectomy with curative intent and use of palliative radiotherapy were indicators for better survival. The prognosis of patients with metastatic leiomyosarcoma is limited and objective responses to first-line systemic therapy are rare. The treatment of metastatic leiomyosarcoma remains an unmet medical need. © 2018 S. Karger GmbH, Freiburg.

  16. Etiologies, outcomes, and prognostic factors of pediatric acute liver failure: A single center's experience in Turkey.

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    Özçay, Figen; Karadağ Öncel, Eda; Barış, Zeren; Canan, Oğuz; Moray, Gökhan; Haberal, Mehmet

    2016-09-01

    Our aim was to determine the etiologies, outcomes, and prognostic indicators in children with acute liver failure. Ninety-one patients who were followed for pediatric acute liver failure (PALF) over a 15-year period were included. Patients who survived with supportive therapy were designated as Group 1, while those who died or underwent liver transplantation were designated as Group 2. There were 37 (40.6%) patients in Group 1 (spontaneous recovery) and 54 (59.4%) patients in Group 2. Thirty-two patients (35.2%) underwent liver transplantation. Infectious and indeterminate causes were the most common etiologies (33% each). Among the infectious causes, hepatitis A (76%) was the most frequent. Hepatic encephalopathy grade 3-4 on admission and during follow-up and high Pediatric Risk of Mortality (PRISM) and Pediatric End-Stage Liver Disease (PELD) scores within the first 24 h were related with a poor prognosis. Group 2 had a more prolonged prothrombin time, higher international normalized ratio, more prolonged activated partial thromboplastin time (aPTT), and higher levels of total and direct bilirubin, ammonia, and lactate (for all, pLiver transplantation was the only curative treatment for patients with poor prognoses and resulted in high survival rates (1-, 5-, and 10-year survival rates of 81.3%, 81.3%, and 75%, respectively) in our study.

  17. Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel

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    Fabio Lavinsky

    2013-06-01

    Full Text Available PURPOSES: Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment. The objective of this study is to describe the clinical characteristics and outcomes of patients with presumed microbial keratitis admitted to The Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel. METHODS: A cross-sectional study was conducted, in which the medical records of patients with presumed microbial keratitis admitted during a period of 3 years were reviewed. RESULTS: Keratitis was diagnosed in 276 patients (51% males and 48.9% females. The mean age was 39.29 ± 22.30 years. The hospital length of stay ranged from 1 to 65 days (mean 5.69 ± 5.508. Fortified antibiotics were still used at discharge in 72% of the cases. Overall visual acuity improved significantly from the time of admission to the 1st-week follow up visit showing a p0.05. The degree of hypopyon and cells in the anterior chamber was significantly related to the hospital length of stay (r Spearman=0.31; p<0.001 and r Spearman=0.21; p<.001, respectively as well as to a worse visual outcome (r Spearman=0.32; p<0.01 and r Spearman=0.18; p=0.01, respectively. Of all patients, 2.3% required an urgent therapeutic penetrating keratoplasty, and 1% underwent evisceration. There was no enucleation. CONCLUSION: Treating keratitis aggressively and assuring patient compliance is imperative for a good final visual outcome. Inpatient treatment may have a positive impact on this outcome.

  18. Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center

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    Luciana dos Santos Tirapani

    2015-03-01

    Full Text Available Introduction: Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV. Objective: To analyze the impact of SV on the outcomes of predialysis patients. Methods: Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009 in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT. Results: Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23 or need for RRT (log rank: 0.17. In the Cox regression model, the hazard ratios (HRs for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41 and 1.47 (CI: 0.35-6.0, respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8 and 2.19 (CI: 0.50-9.6, respectively. Conclusion: These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.

  19. Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center.

    Science.gov (United States)

    Kwek, Jia Liang; Tey, Vanessa; Yang, Liying; Kanagalingam, Devendra; Kee, Terence

    2015-09-01

    Renal and obstetric outcomes in pregnancy after kidney transplantation in Singapore were last studied in 2002. A review of these outcomes in Singapore is now timely following advances in transplant and obstetric medicine. The aim was to evaluate the renal and obstetric outcomes in pregnancy after kidney transplantation in a Singapore tertiary center. Kidney transplant recipients who underwent pregnancy after transplantation at Singapore General Hospital between January 2001 and December 2012 were identified. Data on demographics, comorbidities and clinical outcomes were collected. There were 10 pregnancies identified in nine recipients. The median age of recipient at childbearing was 34.6 years (IQR, 32.8-36.8) and the median interval from transplantation to conception was 69 months (IQR, 38-97). There was no difference between the median pre-pregnancy estimated glomerular filtration rate (eGFR) (47.9 mL/min/1.73 m(2); IQR, 38.4-56.8) and median eGFR at time of last post-partum follow up (43.9 mL/min/1.73 m(2); IQR, 34.5-48.7, P = 0.549). Borderline allograft rejection occurred in one recipient (10.0%) 36 days after birth due to non-adherence to immunosuppressive medication, with subsequent allograft loss 37 months after birth. No mortalities were recorded during the study period. All the 10 pregnancies (100%) ended in singleton live births. Pre-eclampsia occurred in five pregnancies (50.0%), and there were seven (70.0%) preterm deliveries. The median gestational age was 35.4 weeks (IQR, 32.6-38.2) and the median birthweight was 2353 g (IQR, 1811-2648). Post-transplantation pregnancies ended successfully with no significant worsening of allograft function, but they were associated with risks to both recipients and newborns. © 2015 Japan Society of Obstetrics and Gynecology.

  20. Clinical and Patient-centered Outcomes of Nonsurgical Root Canal Retreatment in First Molars Using Contemporary Techniques.

    Science.gov (United States)

    He, Jianing; White, Robert K; White, Cathy A; Schweitzer, Jordan L; Woodmansey, Karl F

    2017-02-01

    There have been many recent technical advances in modern endodontics that have the potential to affect treatment outcomes. Reports on treatment outcomes using contemporary techniques are relatively scarce, especially in the field of nonsurgical retreatment. The purpose of this study was to determine the success of nonsurgical root canal retreatment in molars using contemporary endodontic techniques. Sixty-three patients referred for retreatment in first molars were enrolled in the study. The retreatment procedures were performed by endodontic residents using a semistandardized treatment protocol. Patients were followed-up at 6, 12, and 24 months. Treatment outcomes were categorized into healed, healing, or nonhealing based on clinical and radiographic criteria. Healed and healing were considered as successes, and nonhealing was considered a failure. Outcomes were also evaluated using patient-centered criteria that included oral health-related quality of life scores and subjective chewing ability. Fifty-two of the 63 patients were available for final analysis. Five cases (9.6%) were determined to be nonhealing at the last follow-up with new or persistent periapical lesions. Thirty-seven (71.2%) patients had complete resolution of apical periodontitis, and the remaining 10 (19.2%) remained asymptomatic and showed radiographic evidence of healing. Oral health-related quality of life scores and chewing ability improved significantly over time (P endodontic retreatment using contemporary techniques significantly improved patients' quality of life and chewing ability over time, with a success rate of 90.4% after 2 years. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  1. Outcome of deceased donor renal transplantation - A single-center experience from developing country

    Directory of Open Access Journals (Sweden)

    Himanshu V Patel

    2013-01-01

    Full Text Available Renal transplantation (RTx is considered as the best therapeutic modality for patient suffering from end-stage renal disease (ESRD. Dearth of donor kidneys is a major problem everywhere, and deceased donor renal transplantation (DDRTx is seen as at least a partial solution. Even so, DDRTx accounts for only less than 4% of RTx in India. We report our 6-year single-center experience on DDRTx vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr, rejection episodes, and delayed graft function (DGF. Between January 2005 and March 2011, 236 DDRTx were performed. Majority of the donors were those with brain death due to road traffic/cerebrovascular accidents. The commonest recipient diseases leading to ESRD were chronic glomerulonephritis (42.8%, diabetes (12.7%, and hypertension (10.6%. Mean recipient age was 36.2 ± 14.2 years; 162 were males and 74 were females. Mean donor age was 45.3 ± 17.13 years; 144 were males and 92 were females. Mean dialysis duration pre-transplantation was 18.5 ± 2.5 months. All recipients received single-dose rabbit-anti-thymocyte globulin induction and steroids, calcinueurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Delayed graft function was observed in 29.6% patients and 22% had biopsy-proven acute rejection. Over the mean follow-up of 2.18 ± 1.75 years, patient and graft survival rates were 74.57% and 86.8%, respectively, with mean SCr of 1.42 ± 0.66 mg%. DDRTx achieves acceptable graft function with patient/graft survival, encouraging the use of this approach in view of organ shortage.

  2. Nephrocalcinosis among children at king hussein medical center: Causes and outcome

    Directory of Open Access Journals (Sweden)

    Jwaher T Al-Bderat

    2017-01-01

    Full Text Available Nephrocalcinosis (NC is defined as deposition of calcium crystals in the renal parenchyma and tubules. This is a retrospective review of all the data of 63 children presented to Pediatric Nephrology Clinic at King Hussein Medical Center (KHMC over a 15-year period with bilateral NC. We determine their causes, clinical presentation and evaluate their growth and renal function during their follow-up. Thirty-five (55.5% cases were males and 28 (44.5% were females. The median (range age at presentation was four (2–192 months. The most common leading cause to NC was hereditary tubulopathy in 48% followed by hyperoxaluria in 35%. The cause of NC remained unknown in 3% and Vitamin D excess accounts for 5% of the cases. The most presenting symptom was a failure to thrive (68% and the second most common symptom was abdominal pain and recurrent urinary tract infection was found in 40%, polyuria and polydipsia were found in 32% of cases, and 16% of cases were diagnosed incidentally. At a median follow-up of 38 (14–200 months, estimated glomerular filtration rate had decreased from 84.0 (42–110 mL/min per 1.73 m2 body surface area to 68.2 (10–110 mL/min/1.73 m2 body surface (P = 0.001. This study illustrated the need for a national registry of rare renal diseases to help understand the causes of these conditions in our populations and provide support to affected patients and their families.

  3. Outcomes of Primary Transsphenoidal Surgery in Cushing Disease: Experience of a Tertiary Center.

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    Keskin, Fatma Ela; Ozkaya, Hande Mefkure; Bolayirli, Murat; Erden, Secil; Kadioglu, Pınar; Tanriover, Necmettin; Gazioglu, Nurperi

    2017-10-01

    To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing disease (CD). We included 147 consecutive adult patients with CD who underwent primary transsphenoidal surgery (TSS) between 1998 and 2014 in this study. Eighty-two were followed up in the Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. Patients were requested to attend a long-term remission assessment; 55 could be contacted, and data for the remaining 27 patients' last visit to the outpatient clinics were reviewed for early and late remission. Six patients were excluded from the study. Magnetic resonance imaging (MRI) findings and pathologic results including mitosis, Ki-67 levels, and P53 in immunostaining of all patients were evaluated. Data of 82 patients with CD with an average age of 36 years [interquartile range: 29-47] were analyzed with a mean follow-up of 7.5 years [interquartile range: 5-10]. Overall initial remission rates were 72.3% after TSS. Among the 82 patients, 16 patients had Gamma Knife radiosurgery and 7 patients underwent adrenalectomy. After these additional treatments, the long-term remission rate was found as 69.7%. The highest remission rates were with microadenomas. Recurrence was most frequently seen in patients without tumor evidence on MRI. Patients with high Ki-67 levels had higher recurrence rates in long-term follow-up (P = 0.02). Life-long follow-up for patients with CD seems essential. Undetectable tumors on MRI before TSS and high Ki-67 immunopositivity were found as risk factors for tumor recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Clinical outcomes and prognostic factors of adult's Ewing sarcoma family of tumors: single center experience.

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    Uyeturk, Ummugul; Helvaci, Kaan; Demirci, Ayse; Sonmez, Ozlem Uysal; Turker, Ibrahim; Afsar, Cigdem Usul; Budakoglu, Burcin; Arslan, Ulku Yalcintas; Oksuzoglu, Omur Berna; Zengin, Nurullah

    2016-01-01

    Aim of the study was to investigate the demographics of Ewing sarcoma family of tumours (ESTF) patients, treatment alternatives, clinical outcomes, and prognostic factors for survival. We retrospectively reviewed 39 patients with ESFT who were admitted to our institute between September 2008 and September 2012. The patients included 32 (82.1%) males and seven (17.9%) females of median age 24 (range, 18-66) years. Among the 27 patients with a primary osseous localization, 17 (43.5%) had a central axis localization. Fifteen patients (38.5%) had metastases at the time of diagnosis. Patients were followed up for a median period of 18 (range, 2-134) months. The median event-free survival (EFS) was 23 (range, 1-64) months, and the 1- and 4-year EFS were 60% and 48%, respectively. The median overall survival (OS) was 91 (range, 1-188) months, and the 1- and 4-year OS were 78% and 54%, respectively. Gender, age, primary tumor site, and local treatment modalities, either alone or in combination, did not have a significant effect on OS (p = 0.210, p = 0.617, p = 0.644, and p = 0.417, respectively). In contrast, osseous site of peripheral localization, limited stage, and metastasis to the bone significantly affected OS (p = 0.015, p < 0.001, and p = 0.042, respectively). ESFTs are aggressive tumors with a high rate of relapse and metastatic potential. Patients with peripheral bone involvement and limited stage had a good prognosis. Appropriate surgical resection, radiotherapy, and aggressive chemotherapy regimens are recommended.

  5. Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years.

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    Chandler, William F; Barkan, Ariel L; Hollon, Todd; Sakharova, Alla; Sack, Jayson; Brahma, Barunashish; Schteingart, David E

    2016-02-01

    Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness. To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children. Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol ≤3 μg/dL; type 2 = morning cortisol normal). Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate was 17%, with an average time to recurrence of 4.0 years. Patients with type 1 remission had a lower rate of recurrence (13% type 1 vs 50% type 2) and a longer time to recurrence. Children had similar imaging findings, remission rates, and pathology. There were no operative deaths. Transsphenoidal surgery provides a safe and effective treatment for Cushing disease. For both adults and children, the best outcomes occurred in patients with microadenomas and/or those with type 1 remission.

  6. Neurogenic vision loss: Causes and outcome. An experience from a tertiary center in Northern India

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    Rajesh Verma

    2014-01-01

    Full Text Available Introduction: Vision loss can be a consequence of numerous disorders of eye and neural pathway conveying visual input to brain. A variety of conditions can affect visual pathway producing neurogenic vision loss. The presentation and course of vision loss depends on the site of involvement and underlying etiology. We conducted this unprecedented study to evaluate the characteristics and outcome of various diseases of the visual pathway. Materials and Methods: In this prospective cohort study, we evaluated 64 patients with neurogenic visual impairment. Ophthalmological causes were excluded in all of them. Their presentation, ophthalmological characteristics and investigation findings were recorded. These patients were followed up till 6 months. Results: Out of 69 patients evaluated, 5 were excluded as they had ophthalmological abnormalities. The remaining 64 cases (113 eyes were enrolled. 54 cases were due to diseases of anterior visual pathway and rest 10 had cortical vision loss. The etiologic distribution is as follows: Isolated optic neuritis- 12 (19%, multiple sclerosis- 4 (6.3%, neuromyelitis optica- 5 (7.9%, tubercular meningitis- 15 (23.8%, non-arteritic ischemic optic neuropathy, ischemic optic neuropathy complicating cavernous sinus thrombosis, cryptococcal meningitis, malignant infiltration of optic nerve, Crouzon′s syndrome, calvarial thickening and traumatic occipital gliosis- 1 (1.6% case each, idiopathic intracranial hypertension, pituitary adenoma, acute disseminated encephalomyelitis, posterior reversible leukoencephalopathy- 3 (4.8% cases each, cortical venous thrombosis 5 (7.9%, subacute scleroing panencephalitis- 4 (6.3% cases. Conclusions: The diseases of anterior visual pathway were much more common than cortical vision loss. A majority of our patients had severe impairment of vision at presentation.

  7. Exploring innovative approaches and patient-centered outcomes from positive outliers in childhood obesity.

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    Sharifi, Mona; Marshall, Gareth; Goldman, Roberta; Rifas-Shiman, Sheryl L; Horan, Christine M; Koziol, Renata; Marshall, Richard; Sequist, Thomas D; Taveras, Elsie M

    2014-01-01

    New approaches for obesity prevention and management can be gleaned from positive outliers-that is, individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in high-risk neighborhoods. We collected up to 5 years of height/weight data from the electronic health records of 22,443 Massachusetts children, ages 6 to 12 years, seen for well-child care. We identified children with any history of BMI in the 95th percentile or higher (n = 4007) and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents for focus groups from the subsample of children with negative slopes who also lived in zip codes where >15% of children were obese. We analyzed focus group transcripts using an immersion/crystallization approach. We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited outcomes that mattered most to parents and motivated change were child inactivity, above-average clothing sizes, exercise intolerance, and negative peer interactions; few reported BMI as a motivator. Convergent strategies among positive outlier families were family-level changes, parent modeling, consistency, household rules/limits, and creativity in overcoming resistance. Parents voiced preferences for obesity interventions that include tailored education and support that extend outside clinical settings and are delivered by both health care professionals and successful peers. Successful strategies learned from positive outlier families can be generalized and tested to accelerate progress in reducing childhood obesity. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  8. Association of Centers for Medicare & Medicaid Services Overall Hospital Quality Star Rating With Outcomes in Advanced Laparoscopic Abdominal Surgery.

    Science.gov (United States)

    Koh, Christina Y; Inaba, Colette S; Sujatha-Bhaskar, Sarath; Nguyen, Ninh T

    2017-12-01

    The Centers for Medicare & Medicaid Services (CMS) recently released the Overall Hospital Quality Star Rating to help patients compare hospitals based on a 5-star scale. The star rating was designed to assess overall quality of the institution; thus, its validity toward specifically assessing surgical quality is unknown. To examine whether CMS high-star hospitals (HSHs) have improved patient outcomes and resource use in advanced laparoscopic abdominal surgery compared with low-star hospitals (LSHs). Using the University HealthSystem Consortium database (which includes academic centers and their affiliate hospitals) from January 1, 2013, through December 31, 2015, this administrative database observational study compared outcomes of 72 662 advanced laparoscopic abdominal operations between HSHs (4-5 stars) and LSHs (1-2 stars). The star rating includes 57 measures across 7 areas of quality. Patients who underwent advanced laparoscopic abdominal surgery, including bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass), colorectal surgery (colectomy, proctectomy), or hiatal hernia surgery (paraesophageal hernia repair, Nissen fundoplication), were included. Risk adjustment included exclusion of patients with major and extreme severity of illness. Main outcome measures included serious morbidity, in-hospital mortality, intensive care unit admissions, and cost. A total of 72 662 advanced laparoscopic abdominal operations were performed in patients at 66 HSHs (n = 38 299; mean [SD] age, 51.26 [15.25] years; 12 096 [31.5%] male and 26 203 [68.4%] female; 28 971 [75.6%] white and 9328 [24.4%] nonwhite) and 78 LSHs (n = 34 363; mean [SD] age, 49.77 [14.77] years; 9902 [28.8%] male and 24 461 [71.2%] female; 21 876 [67.6%] white and 12 487 [32.4%] nonwhite). The HSHs were observed to have fewer intensive care unit admissions (1007 [2.6%] vs 1711 [5.0%], P abdominal surgery. No significant difference was found in serious morbidity between HSHs and

  9. Measuring disaster recovery: bouncing back or reaching the counterfactual state?

    Science.gov (United States)

    Cheng, Shaoming; Ganapati, Emel; Ganapati, Sukumar

    2015-07-01

    How should one measure the recovery of a locale from a disaster? The measurement is crucial from a public policy and administration standpoint to determine which places should receive disaster assistance, and it affects the performance evaluation of disaster recovery programmes. This paper compares two approaches to measuring recovery: (i) bouncing back to pre-disaster conditions; and (ii) attaining the counterfactual state. The former centres on returning to normalcy following disaster-induced losses, whereas the latter focuses on attaining the state, using quasi-experimental design, which would have existed if the disaster had not occurred. Both are employed here to assess two housing recovery indicators (total new units and their valuations) in Hurricane Katrina-affected counties (rural and urban). The examination reveals significantly different outcomes for the two approaches: counties have not returned to their pre-disaster housing conditions, but they do exhibit counterfactual recovery. Moreover, rural counties may not be as vulnerable as assumed in the disaster recovery literature. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

  10. Outcome results in children with IgA nephropathy: a single center experience

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    Kaplan Bulut I

    2012-01-01

    Full Text Available Ipek Kaplan Bulut1, Sevgi Mir1, Betul Sozeri1, Mustafa Orhan Bulut2, Sait Sen3, Nida Dincel11Ege University Faculty of Medicine Department of Pediatric Nephrology, 2Ege University Faculty of Medicine Department of Pediatrics, Izmir, 3Ege University Faculty of Medicine Department of Pathology, Izmir, TurkeyBackground: Immunoglobulin A nephropathy (IgAN is the most common primary glomerulonephritis. Patients manifest variable clinical symptoms (eg, microhematuria with preserved or progressive deterioration of renal function resulting in end-stage renal disease. The aim of this study was to evaluate patients from a single center to describe the clinical features, treatments, and follow-up results of those with the disease.Methods: This is a retrospective data study of all children with IgAN. Patients who had a histopathologically proven diagnosis of IgAN and were followed up for at least 5 years were included in the study. Renal biopsy, graded as Hass classification, was performed on all patients. A total of 39 patients were included in the study.Results: The mean follow-up time (± standard deviation was 10.4 ± 3.51 (range 5–16 years. Twenty-nine patients (74.4% were male and ten (25.6% were female. Nineteen (48.7% patients presented with recurrent macroscopic hematuria, ten (25.6% with microscopic hematuria ± proteinuria, six (15.4% with nephritic syndrome, and four (10.3% with nephrotic syndrome. All patients underwent a renal biopsy, which was graded according to the Hass classification. At the end of follow-up time, 18 (46.1% patients were normal, 15 (38.5% had minor urinary abnormalities, three (7.7% had active renal disease, and three (7.7% developed renal failure.Conclusion: The results of the present study are better than those from most other series. The majority of children with IgAN in this study were admitted with recurrent macroscopic hematuria and found to have a good prognosis. We suggest that children with IgAN have a good

  11. Show me the money! An analysis of underserved stakeholders' funding priorities in Patient Centered Outcomes Research domains.

    Science.gov (United States)

    Cargill, Stephanie Solomon; Baker, Lauren Lyn; Goold, Susan Dorr

    2017-07-01

    Develop an accessible exercise to engage underserved populations about research funding priorities; analyze the criteria they use to prioritize research; contrast these criteria to those currently used by Patient Centered Outcomes Research Institute (PCORI). Academic and community partners collaborated to develop an Ipad exercise to facilitate group deliberation about PCOR funding priorities. 16 groups (n = 183) of underserved individuals in both urban and rural areas participated. Recordings were qualitatively analyzed for prioritization criteria. Analysis yielded ten codes, many of which were similar to PCORI criteria, but all of which challenged or illuminated these criteria. Directly involving underserved populations in determining funding criteria is both feasible and important, and can better fulfill PCORI's goal of incorporating patient priorities.

  12. Consideration of the effect for enhancing the disaster prevention awareness by visualization of the tsunami lore

    Science.gov (United States)

    Chiharu, M.

    2017-12-01

    One effective measure for enhancing the residents' disaster prevention awareness is to know the natural hazard which has occurred in the past at residence. Mie Disaster Mitigation Center had released the digital archive for promoting an understanding of disaster prevention on April 28, 2015. This archive is recording the past disaster information as digital catalog. An effective contribution to enhancement of the inhabitants' disaster prevention awareness is expected. It includes the following contents (1) The interview with disaster victim (the 1944 Tonankai Earthquake, The Ise Bay Typhoon and so on) (2) The information on "monument of Tsunami" (3) The description of disaster on the local history material (the school history books, municipal history books, and so on). These contents are being dropped on a map and it is being shown clearly geographically. For all age groups, this way makes it easy to understand that the past disaster information relates to their residence address.

  13. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

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    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  14. The current use of patient-centered/reported outcomes in implant dentistry: a systematic review.

    Science.gov (United States)

    De Bruyn, Hugo; Raes, Stefanie; Matthys, Carine; Cosyn, Jan

    2015-09-01

    To provide an update on the use of Patient-Reported Outcome Measures (PROMs) in the field of implant dentistry (1); to compare PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition (2). The dental literature was searched on PubMed until December 31, 2014, using a general search algorithm. An overall quantitative analysis was performed, and a qualitative appraisal was made on the output of the last 6 years. Per type of edentulism and prosthetic treatment, the general search algorithm was refined in order to select controlled studies comparing PROMs for prostheses supported by one or more implants to alternative treatment options or a healthy dentition. With nearly half of the output (300 of 635) published in the last 6 years, there is a growing interest in PROMs by the scientific community. When scrutinizing the 300 most recent publications, only 84 controlled studies could be identified among which 38 RCTs and 31 cohort studies. An "ad hoc" approach is commonly employed using non-standardized questions and different scoring methods, which may compromise validity and reliability. Overall, 39 eligible papers related to fully edentulous patients treated with an implant overdenture (IOD) and 9 to fully edentulous patients treated with a fixed implant prosthesis (FIP). There is plenty of evidence from well-controlled studies showing that fully edentulous patients in the mandible experience higher satisfaction with an IOD when compared to a conventional denture (CD). This may not hold true for fully edentulous patients in the maxilla. In general, fully edentulous patients seem to opt for a fixed or removable rehabilitation on implants for specific reasons. Data pertaining to partially edentulous patients were limited (FIP: n = 6; single implants: n = 16). In these patients, the timing of implant placement does not seem to affect patient satisfaction. Patients seem to prefer straightforward implant surgery over

  15. Epidemiology, Clinical Features and Outcome of Liver Abscess: A single Reference Center Experience in Qatar

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    Mushtak Talib Abbas

    2014-07-01

    Full Text Available Objective: To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar. Methods: A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from January 1, 2009, to December 31, 2010. Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture. Results: In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 (91% males and six (9% females and their mean age was 47.4 ± 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 (79% patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients (38%. The mean duration of hospitalization was 13.6 ± 8.1 days; the mean duration of antibiotic therapy was 34.7 ± 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 ± 4.1 days, mean duration of therapy was 11.8 ± 2.1 days, and all patients were cured. Conclusion: Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical

  16. Adult-onset intradural spinal teratoma: report of 18 consecutive cases and outcomes in a single center.

    Science.gov (United States)

    Wan, Wei; Yang, Cheng; Yan, Wangjun; Liu, Tielong; Yang, Xinghai; Song, Dianwen; Xiao, Jianru

    2017-07-01

    Eighteen consecutive patients with adult-onset intradural spinal teratoma underwent surgical treatment in our center from 1998 to 2013. Teratoma is defined as a neoplasm composed of elements derived from three germ cell layers (ectoderm, endoderm and mesoderm). Intraspinal teratoma is extremely rare and accounts for 0.2-0.5% of all spinal cord tumors. Moreover, teratoma occurs primarily in neonates and young children. Adult-onset intradural spinal teratoma is even rare. The aim of this study was to discuss the clinical characteristics, diagnosis and therapeutic strategies of adult-onset intradural spinal teratoma. This retrospective study included 18 consecutive adult patients with intradural teratoma who were surgically treated in our center between 1998 and 2013. The clinical features, pathogenesis, diagnostic strategies and surgical outcomes were discussed. Neurological function outcomes were evaluated by the JOA scoring system. Of the 18 included patients, 4 patients received subtotal resection and the other 14 patients received total resection. All the 18 cases were diagnosed with mature teratoma. The mean follow-up period was 79.7 (median 60.5; range 27-208) months. Local recurrence occurred in two of the four patients who underwent subtotal resection and in no patient who underwent total resection. The neurologic status improved in 16 cases and remained unchanged in the other two patients. Adult-onset intradural spinal teratoma is extremely rare. To the best of our knowledge, this is the largest series of patients with this disease. Despite the slow-growth and indolent nature, radical resection remains the recommended treatment to reduce tumor recurrence.

  17. Disaster Management through Experiential Learning

    Science.gov (United States)

    Rijumol, K. C.; Thangarajathi, S.; Ananthasayanam, R.

    2010-01-01

    Disasters can strike at any time, at any place. The world is becoming increasingly vulnerable to natural disasters. From earthquakes to floods and famines, mankind is even more threatened by the forces of nature. The Theme of the 2006 to 2007 International Day for Disaster Reduction was "Disaster Risk Reduction begins at schools" and…

  18. When is exposure to a natural disaster traumatic? Comparison of a trauma questionnaire and disaster exposure inventory.

    Directory of Open Access Journals (Sweden)

    Emily W Harville

    Full Text Available Few studies have compared the sensitivity of trauma questionnaires to disaster inventories for assessing the prevalence of exposure to natural disaster or associated risk for post-disaster psychopathology. The objective of this analysis was to compare reporting of disaster exposure on a trauma questionnaire (Brief Trauma Questionnaire [BTQ] to an inventory of disaster experience. Between 2011 and 2014, a sample of 841 reproductive-aged southern Louisiana women were interviewed using the BTQ and completed a detailed inventory about exposure to hurricanes and flooding. Post-traumatic stress disorder (PTSD symptomology was measured with the Post-Traumatic Stress Checklist, and depression with the Edinburgh Depression Scale. The single question addressing disaster exposure on the BTQ had a sensitivity of between 65% and 70% relative to the more detailed questions. Reporting disaster exposure on the BTQ was more likely for those who reported illness/injury due to a hurricane or flood (74%-77% or danger (77-79%, compared to those who reported damage (69-71% or evacuation (64-68%. Reporting disaster exposure on the BTQ was associated with depression (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.43-3.68. A single question is unlikely to be useful for assessing the degree of exposure to disaster across a broad population, and varies in utility depending on the mental health outcome of interest: the single trauma question is useful for assessing depression risk.

  19. When is exposure to a natural disaster traumatic? Comparison of a trauma questionnaire and disaster exposure inventory.

    Science.gov (United States)

    Harville, Emily W; Jacobs, Marni; Boynton-Jarrett, Renée

    2015-01-01

    Few studies have compared the sensitivity of trauma questionnaires to disaster inventories for assessing the prevalence of exposure to natural disaster or associated risk for post-disaster psychopathology. The objective of this analysis was to compare reporting of disaster exposure on a trauma questionnaire (Brief Trauma Questionnaire [BTQ]) to an inventory of disaster experience. Between 2011 and 2014, a sample of 841 reproductive-aged southern Louisiana women were interviewed using the BTQ and completed a detailed inventory about exposure to hurricanes and flooding. Post-traumatic stress disorder (PTSD) symptomology was measured with the Post-Traumatic Stress Checklist, and depression with the Edinburgh Depression Scale. The single question addressing disaster exposure on the BTQ had a sensitivity of between 65% and 70% relative to the more detailed questions. Reporting disaster exposure on the BTQ was more likely for those who reported illness/injury due to a hurricane or flood (74%-77%) or danger (77-79%), compared to those who reported damage (69-71%) or evacuation (64-68%). Reporting disaster exposure on the BTQ was associated with depression (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.43-3.68). A single question is unlikely to be useful for assessing the degree of exposure to disaster across a broad population, and varies in utility depending on the mental health outcome of interest: the single trauma question is useful for assessing depression risk.

  20. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

    Science.gov (United States)

    Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish

    2016-09-07

    Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. Copyright © 2016 by the American Society of Nephrology.

  1. Use of the Satinsky clamp for hilar clamping during robotic partial nephrectomy: indications, technique, and multi-center outcomes.

    Science.gov (United States)

    Abdullah, Newaj; Rahbar, Haider; Barod, Ravi; Dalela, Deepansh; Larson, Jeff; Johnson, Michael; Mass, Alon; Zargar, Homayoun; Kaouk, Jihad; Allaf, Mohamad; Bhayani, Sam; Stifelman, Michael; Rogers, Craig

    2017-03-01

    A Satinsky clamp may be a backup option for hilar clamping during robotic partial nephrectomy (RPN) if there are challenges with application of bulldog clamps, but there are potential safety concerns. We evaluate outcomes of RPN using Satinsky vs. bulldog clamps, and provide tips for safe use of the Satinsky as a backup option. Using a multi-center database, we identified 1073 patients who underwent RPN between 2006 and 2013, and had information available about method of hilar clamping (bulldog clamp vs. Satinsky clamp). Patient baseline characteristics, tumor features, and perioperative outcomes were compared between the Satinsky and bulldog clamp groups. A Satinsky clamp was used for hilar clamping in 94 (8.8 %) RPN cases, and bulldog clamps were used in 979 (91.2 %) cases. The use of a Satinsky clamp was associated with greater operative time (198 vs. 175 min, p clamp group, but none were directly related to the Satinsky clamp. On multivariable analysis, the use of the Satinsky clamp was not associated with increase in intraoperative or Clavien ≥3 postoperative complications, positive surgical margin rate or percentage change in estimated glomerular filtration rate. A Satinsky clamp can be a backup option for hilar clamping during challenging RPN cases, but requires careful technique, and was rarely necessary.

  2. Integrated Research on Disaster Risk - A Review

    Science.gov (United States)

    Beer, T.

    2016-12-01

    Integrated Research on Disaster Risk, generally known as IRDR, is a decade-long research programme co-sponsored by the International Council for Science (ICSU), the International Social Science Council (ISSC), and the United Nations International Strategy for Disaster Reduction (UNISDR). It is a global, multi-disciplinary approach to dealing with the challenges brought by natural disasters, mitigating their impacts, and improving related policy-making mechanisms. The home page is at: http://www.irdrinternational.org/The research programme was named Integrated Research on Disaster Risk to indicate that it is addressing the challenge of natural and human-induced environmental hazards. In November 2008 and May 2009 respectively, both the ISSC and the UNISDR agreed to join the ICSU in co-sponsoring the IRDR programme. Although the approaches in the sciences vary, the IRDR programme approaches the issues of natural and human-induced hazards and disasters from several perspectives: from the hazards to the disasters, and from the human exposures and vulnerabilities back to the hazards. This coordinated and multi-dimensional approach takes the IRDR programme beyond approaches that have traditionally been undertaken To meet its research objectives the IRDR established four core projects, comprising working groups of experts from diverse disciplines, to formulate new methods in addressing the shortcomings of current disaster risk research. Assessment of Integrated Research on Disaster Risk (AIRDR) Disaster Loss Data (DATA) Forensic Investigations of Disasters (FORIN) Risk Interpretation and Action (RIA) Dr Tom Beer was a member of both the scoping and planning groups and was a member of the committee to undertake a mid-term review of IRDR with the terms of reference being to examine and to report by November 2016. 1. Strategic planning and implementation 2. Governance 3. Secretariat, funding and operations 4. Stakeholders and partnerships 5. Communication, visibility and

  3. Natural disasters and the lung.

    Science.gov (United States)

    Robinson, Bruce; Alatas, Mohammad Fahmi; Robertson, Andrew; Steer, Henry

    2011-04-01

    As the world population expands, an increasing number of people are living in areas which may be threatened by natural disasters. Most of these major natural disasters occur in the Asian region. Pulmonary complications are common following natural disasters and can result from direct insults to the lung or may be indirect, secondary to overcrowding and the collapse in infrastructure and health-care systems which often occur in the aftermath of a disaster. Delivery of health care in disaster situations is challenging and anticipation of the types of clinical and public health problems faced in disaster situations is crucial when preparing disaster responses. In this article we review the pulmonary effects of natural disasters in the immediate setting and in the post-disaster aftermath and we discuss how this could inform planning for future disasters. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

  4. The impact of Vascular Access on the Adequacy of Dialysis and the Outcome of the Dialysis Treatment: One Center Experience.

    Science.gov (United States)

    Mutevelic, Alma; Spanja, Indira; Sultic-Lavic, Indira; Koric, Amila

    2015-04-01

    Chronic kidney disease (CKD) is a gradually reduction in glomerular filtration rate (GFR) caused by destruction of a large number of nephrons. Kidney failure is the final stage of CKD with GFR vascular access, which is also the "life line" and "Achilles heel" of hemodialysis treatment. The purpose of this research is to show the demographic structure of the hemodialysis center in Konjic, and also demonstrate the impact of vascular access to the adequacy and the outcome of dialysis treatment. This cross-sectional study included 36 patients on hemodialysis in Center in Konjic from September 2010 to December 2014. The method of collecting data is performed through medical records and the quality of dialysis is taken to be Kt/V> 1.2. Statistical analysis was performed using SPSS software and Student T-test. The mortality of patients treated by dialysis is 37.8%. The ratio of male and female patients is 55.6% vs. 44.5%, with an average age of 52.91±14.36 years and an average duration of hemodialysis of five years. The highest percentage of patients dialyzed through arterio-venous fistula (AVF) on the forearm (72.2%). In that patients the most common complication is thrombosis with 30.5%, which require recanalization in 11% and replacement in 19.5% of patients. Of the other dialysis patients, 16.7% of patients are dialyzed via a temporary and 11.1% via a permanent catheter (the most common complication in that patients is infection in 83.3% cases) in v.subclavia. Although the AVF is more frequently, experience shows frequent implantation of a permanent catheter in elderly patients due to the less quality of their blood vessels. Although the Kt/V by patients who are dialyzed through temporary catheter is less than 1.2 and by the other two access is greater than 1.2, our results confirm that vascular access does not have an influence on quality of dialysis. Average Kt/V shows that the adequate dialysis dose is delivered in this Center, which means that despite the impact

  5. Safety and quality outcomes in peritoneal surface malignancy patients: developing a national center for excellence in Colombia.

    Science.gov (United States)

    Arias, Fernando; Herrera-Almario, Gabriel; Pozo, Marcos E; Londoño-Schimmer, Eduardo; Otero, Jorge M; Cardona, Andres; Cortes, Natalia; Mora, Marta

    2015-05-01

    Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is being used more frequently for the treatment of peritoneal surface malignancies. There are a paucity of data regarding safety and quality outcomes in this group of patients. The aim of this study was to evaluate safety events and quality measures in a group of patients who underwent CRS + HIPEC. All patients who underwent CRS + HIPEC procedures between December 2007 and March 2014 were included. All safety-related events and quality outcomes were reviewed. Major events were defined as occurrences in which there was harm to patient or healthcare personnel. Minor events were defined as quality or safety events in which there was potential for damage. A total of 72 patients were included. The mean Peritoneal Cancer Index for the study group was 20.5. One hundred percent compliance for informed consent, patient identification and surgical site marking, and antibiotic and venous thromboembolism prophylaxis guidelines was identified. The incidence of major safety events was 37.5 %. Minor events occurred in 47.2 % of patients. There was a 2.78 % 30-day mortality in the study group. One in three patients undergoing CRS + HIPEC procedures experienced a major safety or quality event before, during, or after surgery. Adequate surgical care alone is not sufficient to prevent these occurrences. Active surveillance of safety events and quality leads to early detection and development of improvement plans. New CRS + HIPEC centers need to adhere to strict safety and quality guidelines to ensure excellent patient outcomes.

  6. Outcomes for primary kidney transplantation from donation after Citizens' death in China: a single center experience of 367 cases.

    Science.gov (United States)

    Xue, Wujun; Tian, Puxun; Xiang, Heli; Ding, Xiaoming; Pan, Xiaoming; Yan, Hang; Hou, Jun; Feng, Xinshun; Liu, Linjuan; Ding, Chenguang; Tian, Xiaohui; Li, Yang; Zheng, Jin

    2017-04-04

    The cases of donation after brain death followed by circulatory death (DBCD) and donation after cardiac death (DCD) have been increased year by year in China. Further research is needed to understand in the outcomes and risk factors of delayed graft function (DGF) in order to minimize the risk of DGF and ameliorate its potential impact on long-term outcomes. This study was to explore the differences in outcomes between DBCD and DCD transplant and the main risk factors for DGF in DBCD. Retrospective analysis of the clinical data of 367donations after citizens' death kidney transplant procedures (donors and recipients) between July 2012 and August 2015 at our center. During the study period, the donation success rate was 25.3%. 164 cases of DBCD and 35 cases of DCD had been implemented and 367 kidneys were transplanted. The incidence of DGF in DBCD group were significantly lower than that of DCD group (12.0% vs. 27.0%, p = 0.002). The 1-year percent freedom from acute rejection (AR) was significantly higher in DBCD group compared with it of DCD group (94% vs. 82%, p = 0.036). Multivariate logistic regression analysis of the kidney transplants revealed that the high risk factors for DGF after renal transplantation in DBCD were history of hypertension (Odds Ratio [OR] = 5.88, 95% CI: 1.90 to 18.2, p = 0.002), low blood pressure (BP factors for DGF in DBCD kidney transplants are donors with a history of hypertension, low blood pressure, and serum creatinine of donor before donation.

  7. Obstetric and long-term kidney outcomes in renal transplant recipients: a 40-yr single-center study.

    Science.gov (United States)

    Stoumpos, Sokratis; McNeill, Susan H; Gorrie, Morag; Mark, Patrick B; Brennand, Janet E; Geddes, Colin C; Deighan, Christopher J

    2016-06-01

    Female renal transplant recipients of childbearing age may ask what the outcomes are for pregnancy and whether pregnancy will affect graft function. We analyzed obstetric and transplant outcomes among renal transplant recipients in our center who have been pregnant between 1973 and 2013. A case-cohort study was performed identifying 83 pairs of pregnant and non-pregnant controls matched for sex, age, transplant vintage, and creatinine. There were 138 pregnancies reported from 89 renal transplant recipients. There were live births in 74% of pregnancies with high prevalence of prematurity (61%), low birth weight (52%), and pre-eclampsia (14%). Lower eGFR (OR 0.98; p = 0.05) and higher uPCR (OR 1.86; p = 0.02) at conception were independent predictors for poor composite obstetric outcome. Lower eGFR (OR 0.98; p = 0.04), higher uPCR (OR 1.50; p = 0.04), and live organ donation (OR 0.35; p = 0.02) were predictors of ≥20% loss of eGFR between immediately pre-pregnancy and one yr after delivery. There was no difference in eGFR at one, five, and 10 yr in pregnant women compared with non-pregnant controls and a pregnancy was not associated with poorer 10-yr transplant or 20-yr patient survival. Despite high rates of obstetric complications, most women had successful pregnancies with good long-term transplant function. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Leadership success within disaster restoration projects.

    Science.gov (United States)

    Rapp, Randy R; Baroudi, Bassam

    2014-01-01

    Successful project managers draw their performance from essential leadership traits, as guided by their core values.Within disaster recovery, contractors who mitigate, repair, and reconstruct the built environment are often faced with challenges exceeding the norm. The effective leader is commonly expected to consider stakeholder motivations within distressing situations as well as other external and environmental factors when seeking to lead the project team to successful outcomes. This research is most concerned with leadership within the context of disaster restoration of the built environment. Its stimulus comes from the Restoration Industry Association (RIA)'s efforts to highlight leadership traits and core values for its Certified Restorer Body of Knowledge but would be of value to others associated with disaster recovery operations. Among organizations whose membership includes thousands of practitioners who restore and reconstruct the built environment after disasters, the RIA is the only one yet to formally and substantially research which core values and leader traits are deemed critical for the success of efforts to manage the means and methods applied on recovery job sites. Forty-six seasoned disaster restoration industry project professionals voluntarily responded to a survey questionnaire that sought their opinions about the traits and core values that they consider most important for successful disaster restoration project leadership. The most important leader traits were effective communication, professional competence, and leadership by example. The most important restoration industry values were integrity, compassion, and trustworthiness. The recognized imperative of compassion was unexpected in light of stereotypes often associated with construction-related contractors. This and other findings permit disaster response and recovery stakeholders to better understand qualities they should wish to see in leaders of contractor organizations, which

  9. Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

    Science.gov (United States)

    Hartzler, Andrea L; Chaudhuri, Shomir; Fey, Brett C; Flum, David R; Lavallee, Danielle

    2015-01-01

    The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients-physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient

  10. An Analysis of the Effect of Race, Socioeconomic Status and Center Size on Unrelated NMDP Donor Outcomes: Donor Toxicities are More Common at Low Volume Bone Marrow Collection Centers

    OpenAIRE

    Shaw, Bronwen E.; Logan, Brent R.; Kiefer, Deidre M.; Chitphakdithai, Pintip; Pedersen, Tanya L.; Abdel-Azim, Hisham; Abidi, Muneer H.; Akpek, Gorgun; Diaz, Miguel A.; Artz, Andrew S.; Dandoy, Christopher; Gajewski, James L.; Hematti, Peiman; Kamble, Rammurti T.; Kasow, Kimberley A.

    2015-01-01

    Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index (BMI), and age in unrelated donors undergoing collection at National Marrow Donor Program (NMDP) centers. We hypothesized that other important factors (race, socioeconomic status (SES), and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2,726 bone marrow (BM) and 6,768 peripheral blood stem cell (PBSC) donors collected...

  11. Implementing a Disaster Preparedness Curriculum for Medical Students.

    Science.gov (United States)

    Jasper, Edward H; Wanner, Gregory K; Berg, Dale; Berg, Katherine

    2017-08-01

    Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting. Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree). A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5). Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago

  12. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care.

    Science.gov (United States)

    Xian, Ying; O'Brien, Emily C; Fonarow, Gregg C; Olson, DaiWai M; Schwamm, Lee H; Hannah, Deidre; Lindholm, Brianna; Maisch, Lesley; Lytle, Barbara L; Greiner, Melissa A; Wu, Jingjing; Peterson, Eric D; Pencina, Michael J; Hernandez, Adrian F

    2015-07-01

    Stroke is common and costly, annually depriving the lives and well-being of 800,000 Americans. Despite demonstrated efficacy in clinical trials, questions remain about the safety and clinical effectiveness of various treatment options given patient characteristics, conditions, preferences, and their desired outcomes. The Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-sponsored project designed to help patients, physicians, and other stakeholders make informed decisions regarding stroke care and improve outcomes through patient-centered comparative effectiveness research. The primary outcomes identified and prioritized by stroke patients are "home time" (time spent alive and outside a hospital) and major adverse cardiovascular events. With inputs from stroke patients themselves, a series of comparative safety and effectiveness analyses will be performed across 3 prioritized therapeutic areas identified as important by stroke survivors: oral anticoagulants, statin therapy, and antidepressants. We obtained data from Get With the Guidelines-Stroke linked with Medicare claims and follow-up telephone interviews. Our combined retrospective and prospective research strategy allows the evaluation of the safety and effectiveness of various treatment options and patient-centered longitudinal outcomes. To ensure the rapid translation of findings into clinical practice, results will be disseminated to stroke survivors, caregivers, and health care providers through traditional and social media, including an online decision aid tool. PROSPER is a patient-centered outcome research study guided by patients, caregivers, and the broader health care community. By addressing knowledge gaps in treatment uncertainties through comparative effectiveness research, PROSPER has the potential to improve decision making in stroke care and patient outcomes reflecting individual patient

  13. Virtual reality disaster training: translation to practice.

    Science.gov (United States)

    Farra, Sharon L; Miller, Elaine T; Hodgson, Eric

    2015-01-01

    Disaster training is crucial to the mitigation of both mortality and morbidity associated with disasters. Just as clinical practice needs to be grounded in evidence, effective disaster education is dependent upon the development and use of andragogic and pedagogic evidence. Educational research findings must be transformed into useable education strategies. Virtual reality simulation is a teaching methodology that has the potential to be a powerful educational tool. The purpose of this article is to translate research findings related to the use of virtual reality simulation in disaster training into education practice. The Ace Star Model serves as a valuable framework to translate the VRS teaching methodology and improve disaster training of healthcare professionals. Using the Ace Star Model as a framework to put evidence into practice, strategies for implementing a virtual reality simulation are addressed. Practice guidelines, implementation recommendations, integration to practice and evaluation are discussed. It is imperative that health educators provide more exemplars of how research evidence can be moved through the various stages of the model to advance practice and sustain learning outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Disaster Distress Helpline: Wildfires

    Science.gov (United States)

    ... natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to ... risk for emotional distress due to wildfires include: Children and teens . After a wildfire, young people may ...

  15. Resilience in disaster research

    DEFF Research Database (Denmark)

    Dahlberg, Rasmus; Johannessen-Henry, Christine Tind; Raju, Emmanuel

    2015-01-01

    This paper explores the concept of resilience in disaster management settings in modern society. The diversity and relatedness of ‘resilience’ as a concept and as a process are reflected in its presentation through three ‘versions’: (i) pastoral care and the role of the church for victims...... of disaster trauma, (ii) federal policy and the US Critical Infrastructure Plan, and (iii) the building of resilient communities for disaster risk reduction practices. The three versions aim to offer characteristic expressions of resilience, as increasingly evident in current disaster literature....... In presenting resilience through the lens of these three versions, the article highlights the complexity in using resilience as an all-encompassing word. The article also suggests the need for understanding the nexuses between risk, vulnerability, and policy for the future of resilience discourse....

  16. A Peanut Butter Disaster

    Science.gov (United States)

    Vento, Carla J.

    1976-01-01

    A discussion of how cross-age tutoring was used with older pupils helping younger ones by making media curriculum materials. How this method was applied to disaster preparedness education is described. (HB)

  17. Integrating the disaster cycle model into traditional disaster diplomacy concepts.

    Science.gov (United States)

    Callaway, David W; Yim, Eugene S; Stack, Colin; Burkle, Frederick M

    2012-03-01

    Disaster diplomacy is an evolving contemporary model that examines how disaster response strategies can facilitate cooperation between parties in conflict. The concept of disaster diplomacy has emerged during the past decade to address how disaster response can be leveraged to promote peace, facilitate communication, promote human rights, and strengthen intercommunity ties in the increasingly multipolar modern world. Historically, the concept has evolved through two camps, one that focuses on the interactions between national governments in conflict and another that emphasizes the grassroots movements that can promote change. The two divergent approaches can be reconciled and disaster diplomacy further matured by contextualizing the concept within the disaster cycle, a model well established within the disaster risk management community. In particular, access to available health care, especially for the most vulnerable populations, may need to be negotiated. As such, disaster response professionals, including emergency medicine specialists, can play an important role in the development and implementation of disaster diplomacy concepts.

  18. Developing disaster resilient housing in Vietnam challenges and solutions

    CERN Document Server

    Tran, Tuan Anh

    2016-01-01

    This book provides a comprehensive understanding on disaster resilient housing within the Vietnam context particularly and the developing world generally. The book has identified the root causes of housing vulnerability, restrictions to safe housing development, concepts of disaster resilient housing, key issues/factors implementers and building designers need to consider, and ways of achieving resilient housing outcomes in actual design projects. The design and development of disaster resilient housing has been framed into three main themes:  (i) community consultation, (ii) the role of built-environment professionals and (iii) design responses for resilience.   To achieve these themes, there is a variety of contextual and intervening conditions that need to be addressed and met to provide an enabling environment for promoting disaster resilient housing. These three themes are among the most arguable issues in recent debates and discussions, academically and practically, regarding disaster risk reduction ...

  19. Developing a patient-centered outcome measure for complementary and alternative medicine therapies I: defining content and format

    Directory of Open Access Journals (Sweden)

    Ritenbaugh Cheryl

    2011-12-01

    Full Text Available Abstract Background Patients receiving complementary and alternative medicine (CAM therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately. Methods From a database of patient interviews (n = 177 from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation. Results The resulting questionnaire contained 18 items, in visual analog scale format

  20. Enhancing Global Health Security: US Africa Command's Disaster Preparedness Program.

    Science.gov (United States)

    Morton Hamer, Melinda J; Reed, Paul L; Greulich, Jane D; Beadling, Charles W

    2018-03-07

    US Africa Command's Disaster Preparedness Program (DPP), implemented by the Center for Disaster and Humanitarian Assistance Medicine, partnered with US Government agencies and international organizations to promote stability and security on the African continent by engaging with African Partner Nations' (PN) civil and military authorities to improve disaster management capabilities. From 2008 to 2015, DPP conducted disaster preparedness and response programming with 17 PNs. DPP held a series of engagements with each, including workshops, strategic planning, developing preparedness and response plans, tabletop exercises, and prioritizing disaster management capability gaps identified through the engagements. DPP partners collected data for each PN to further capacity building efforts. Thus far, 9 countries have completed military pandemic plans, 10 have developed national pandemic influenza plans, 9 have developed military support to civil authorities plans, and 11 have developed disaster management strategic work plans. There have been 20 national exercises conducted since 2009. DPP was cited as key in implementation of Ebola response plans in PNs, facilitated development of disaster management agencies in DPP PNs, and trained nearly 800 individuals. DPP enhanced PNs' ability to prepare and respond to crises, fostering relationships between international agencies, and improving civil-military coordination through both national and regional capacity building. (Disaster Med Public Health Preparedness. 2018;page 1 of 11).

  1. Review: Health Management in Disasters with Focusing on Rehabilitation

    Directory of Open Access Journals (Sweden)

    Hamid Reza Khankeh

    2008-07-01

    Full Text Available Disasters should never be considered as routine. Disasters of any kind—natural or manmade—clearly disrupt the normal functioning of any community and frequently overwhelm both personal and community resources. In the post-disaster context, following the initial shock of the disaster, returning lives and livelihoods to normalcy becomes a primary concern of the affected communities and nations. Traditionally, this has been known as the recovery and rehabilitation phase, where "normalcy" refers to the return of the community to the state it was in prior to the disaster event. Rehabilitation is this process of returning the community to “normal” that may extend for many years and involves the physical, social and economic components of the community. Disasters can take on a life of their own, therefore being prepared is the single most effective way to improve outcomes. Proper pre-event planning and providing mechanisms for resource coordination are critical which will be resulted a successful response. It should focus on increasing the participation of civil authorities in order to reestablish local authorities. In order to develop safer communities with fewer deaths, physical injuries, and psycho-social trauma following disasters, health systems must be capable of providing a coordinated response during disasters and of delivering effective mitigation and preparedness programs before disaster impact. The health sector has a vested interest and a key role in this process. In addition, prior to the occurrence of disasters, national, provincial, and local planning should be blueprinted by managers. The public must be educated regarding the importance of individual and family preparation for disaster

  2. Developing a patient-centered outcome measure for complementary and alternative medicine therapies II: refining content validity through cognitive interviews.

    Science.gov (United States)

    Thompson, Jennifer J; Kelly, Kimberly L; Ritenbaugh, Cheryl; Hopkins, Allison L; Sims, Colette M; Coons, Stephen J

    2011-12-29

    Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews. We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire. The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience. We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide

  3. Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom.

    Science.gov (United States)

    Garg, Scot; Anderson, Simon G; Oldroyd, Keith; Berry, Colin; Emdin, Connor A; Peters, Sanne A E; West, Nick E J; Kelly, Damian; Balachandran, Kanarath; McDonald, John; Singh, Ravi; Devadathan, Sen; Redwood, Simon; Ludman, Peter F; Rahimi, Kazem; Woodward, Mark

    2015-07-28

    Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p backup is not associated with any mortality hazard. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Long Term Outcomes of Pediatric En Bloc Kidney Transplantation: A Single Center Experience with 25 Years Follow Up.

    Science.gov (United States)

    Sureshkumar, Kalathil K; Habbach, Amr; Tang, Amy; Chopra, Bhavna

    2018-01-18

    Pediatric en bloc kidneys are considered marginal for transplantation into adults. We aimed to compare the long-term outcomes of pediatric en bloc vs. living donor kidney transplantation. A retrospective review was undertaken on pediatric en bloc and living donor kidney transplants performed at our center between 1990 and 2001. The outcomes compared between the groups included 25 year graft survival and longitudinal glomerular filtration rate (GFR). There were 72 pediatric en bloc and 75 living donor kidney recipients included in the analysis. Pediatric donors were 16.9 ± 11.2 months old and weighed 10.7±3.8 kg with terminal serum creatinine of 0.50±0.45 mg/dl. Living donors were 40.1±9.4 years old and serum creatinine was 0.90±0.16 mg/dl at the time of donation. En bloc kidney recipients had higher dialysis vintage (23.0 ± 29.2 vs. 14.3 ± 14.7 months, p=0.03), and longer cold ischemia time (30.5± 9.8 vs. 2.6 ±0.9 hours, pen bloc kidney recipients from years five through 17 post-transplantation. Pediatric en bloc kidneys conferred long-term graft survival similar to living donor kidneys over a 25 year period following transplantation along with superior graft function. These findings support improved utilization of pediatric kidneys for transplantation into adults which not only helps to alleviate organ shortage but also provide excellent long-term function.

  5. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland.

    LENUS (Irish Health Repository)

    Saeed, Ayman

    2012-02-01

    AIM: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). METHODS: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. RESULTS: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +\\/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+\\/-standard deviation) at presentation: 0.76 (+\\/-0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+\\/-0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). CONCLUSIONS: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.

  6. [Long-term outcome following multiple trauma in working age : A prospective study in a Swiss trauma center].

    Science.gov (United States)

    Gross, T; Amsler, F

    2016-11-01

    Given the lack of data in the available literature, we were interested in the disability rate and corresponding insurance costs following multiple trauma in Switzerland. The possible impact of demographic, traumatic and hospital process factors as well as subjective and objective longer-term outcome variables on insurance data acquired were examined. Following multiple trauma the clinical and socioeconomic parameters in 145 survivors of working age were investigated over 2 and 4 years post-injury at a Swiss trauma center (University Hospital Basel). The correlation with the corresponding data provided by the largest Swiss accident insurance company (Suva, n = 63) was tested by univariate and multivariate analysis and patients insured at Suva were compared with those insured elsewhere (n = 82). The mean level of disability in this cohort of multiple trauma patients insured at Suva was 43 %. The insurer expected costs of more than 1 million Swiss Francs per multiply injured patient. In univariate analysis, only discrete correlations (maximum r = 0.37) were found with resulting disability, but significant correlations were found in subsequent multivariate testing most of all for age and the sequential organ failure assessment (SOFA 11 % and 15 % predictive capacity, p = 0.001; corrected R 2  = 0.26). Among variables of longer-term outcome the Euro Quality of Life Group health-related quality of life in five dimensions (EQ-5D) correlated almost as highly with the objective extent of disability as did the reduced capacity to work declared by the patients (0.64 and 0.7, respectively). The estimation of long-term disability following multiple trauma based on primary data following injury appears to be possible only to a limited extent. Given the clinical and socioeconomic relevance, comparable analyses are necessary by including all insurance providers involved.

  7. Kidney Transplant Outcomes After Primary, Repeat and Kidney After Nonrenal Solid Organ Transplantation: A Single-Center Experience.

    Science.gov (United States)

    Sood, Puneet; Gao, Xiaotian; Mehta, Rajil; Landsittel, Douglas; Wu, Christine; Nusrat, Rabeeya; Puttarajappa, Chethan; Tevar, Amit D; Hariharan, Sundaram

    2016-06-01

    Improvements in renal allograft outcomes have permitted kidney transplantation after prior kidney allograft failure as well as after nonrenal solid organ transplantation. This study compares renal allograft outcomes in the 3 groups, that is, primary, repeat, and kidney after nonrenal solid organ transplantation, where transplant group was coded as a time-dependent variable. We retrospectively reviewed registry data for kidney transplant recipients at University of Pittsburgh Medical Center from January 2000 to December 2011. We compared overall graft survival between the 3 groups using Cox regression modeling. We calculated 1-, 3-, and 5-year graft survival and half-lives for each group where feasible. The study cohort (N = 2014) consisted of group A (primary kidney transplant, n = 1578, with 7923.2 years of follow-up time), group B (repeat kidney transplant, n = 314, with 1566.7 years of follow-up time) and group C (kidney post-nonrenal solid organ transplant, n = 176, with 844.8 years of follow-up time). Of the 1578 patients in the primary kidney transplant group, 74 later received a repeat transplant and thus also have follow-up counted in the repeat kidney transplant group. The median follow-up was 56, 53, and 55 months, respectively. The 5-year actuarial and death-censored graft survival was 68.69%, 68.79%, and 66.48% and 65.53%, 67.68%, and 62.92%, respectively (P = 0.70). There was no difference in overall graft survival in the Cox-adjusted analysis (group B: odds ratio, 1.02; 95% confidence interval, 0.84-1.26; P = 0.79; group C: odds ratio, 0.96; 95% confidence interval, 0.75-1.23; P = 0.76). The adjusted kidney graft survivals in the 3 groups were similar.

  8. Associations of family-centered care with health care outcomes for children with special health care needs.

    Science.gov (United States)

    Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

    2011-08-01

    The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

  9. Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey.

    Science.gov (United States)

    Dulundu, Ender; Attaallah, Wafi; Tilki, Metin; Yegen, Cumhur; Coskun, Safak; Coskun, Mumin; Erdim, Aylin; Tanrikulu, Eda; Yardimci, Samet; Gunal, Omer

    2017-05-23

    The optimal surgical strategy for treating colorectal cancer with synchronous liver metastases is subject to debate. The current study sought to evaluate the outcomes of simultaneous colorectal cancer and liver metastases resection in a single center. Prospectively collected data on all patients with synchronous colorectal liver metastases who underwent simultaneous resection with curative intent were analyzed retrospectively. Patient outcomes were compared depending on the primary tumor location and type of liver resection (major or minor). Between January 2005 and August 2016, 108 patients underwent simultaneous resection of primary colorectal cancer and liver metastases. The tumor was localized to the right side of the colon in 24 patients (22%), to the left side in 40 (37%), and to the rectum in 44 (41%). Perioperative mortality occurred in 3 patients (3%). Postoperative complications were noted in 32 patients (30%), and most of these complications (75%) were grade 1 to 3 according to the Clavien-Dindo classification. Neither perioperative mortality nor the rate of postoperative complications after simultaneous resection differed among patients with cancer of the right side of the colon, those with cancer of the left side of the colon, and those with rectal cancer (4%, 2.5%, and 2%, respectively, p = 0.89) and (17%, 33%, and 34%, respectively; p = 0.29)]. The 5-year overall survival of the entire sample was 54% and the 3-year overall survival was 67 %. In conclusion, simultaneous resection for primary colorectal cancer and liver metastases is a safe procedure and can be performed without excess morbidity in carefully selected patients regardless of the location of the primary tumor and type of hepatectomy.

  10. Impact of physician assistants on the outcomes of patients with acute myelogenous leukemia receiving chemotherapy in an academic medical center.

    Science.gov (United States)

    Glotzbecker, Brett E; Yolin-Raley, Deborah S; DeAngelo, Daniel J; Stone, Richard M; Soiffer, Robert J; Alyea, Edwin P

    2013-09-01

    Inpatient academic medical center care historically has been delivered by faculty physicians in conjunction with physicians in training (house officers [HOs]). Alternative staffing models have emerged secondary to American Counsel for Graduate Medical Education work-hour restrictions. The purpose of this study was to assess the quality of acute myelogenous leukemia (AML) care provided by a physician assistant (PA) service compared with a traditional model. Data were retrospectively collected on patients admitted with AML for reinduction chemotherapy from 2008 to 2012. Primary outcome measures were inpatient mortality and length of stay (LOS). Secondary measures included readmissions, intensive care unit (ICU) transfers, consults requested, and radiologic studies ordered. Ninety-five patients with AML were reviewed. Forty-seven patients (49.5%) were admitted to the HO service, and 48 patients (50.5%) were admitted to the PA service. Demographic data were similar between services. LOS was significantly different between the services, with a mean of 36.8 days with the HO model compared with 30.9 days with the PA service (P=.03). The 14-day readmission rate also differed significantly; it was 10.6% (five of 47 patients) and zero for the HO and PA models, respectively (P=.03). The mean number of consults with the HO model was 2.11 (range, zero to five) versus 1.47 (range, zero to four) with the PA service (P=.03). Mortality and ICU transfers were not significantly different. The data demonstrate equivalent mortality and ICU transfers, with a decrease in LOS, readmission rates, and consults for patients cared for in the PA service. This suggests that the PA service is associated with increased operational efficiency and decreased health service use without compromising health care outcomes.

  11. The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV.

    Science.gov (United States)

    Powell, Anna M; DeVita, Julia M; Ogburu-Ogbonnaya, Amartha; Peterson, Andrea; Lazenby, Gweneth B

    2017-08-01

    Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.

  12. Budd–Chiari Syndrome in Young Chinese: Clinical Characteristics, Etiology and Outcome of Recanalization from a Single Center

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Wen-Jie, E-mail: 776260859@qq.com; Cui, Yan-Feng, E-mail: cuiyanfeng366@126.com; Zu, Mao-Heng, E-mail: cjr.zumaoheng@vip.163.com; Zhang, Qing-Qiao, E-mail: 1427286069@qq.com; Xu, Hao, E-mail: xuhao585@yeah.net [Affiliated Hospital of Xuzhou Medical College, Department of Interventional Radiology (China)

    2016-04-15

    PurposeWe aimed to characterize the clinical profile, etiology, and outcomes of young Chinese patients with Budd–Chiari syndrome treated with recanalization.MethodsA total of 35 consecutive young patients (≤25 years of age) with primary Budd–Chiari syndrome treated with recanalization at our center were enrolled in this study between March 2011 and December 2014. Data on baseline information, etiology tests, therapeutic recanalization strategies, and follow-up were collected.ResultsThe most common clinical feature was ascites, present in 33 cases (94 %). Hepatic vein obstruction was present in 60 % (21/35) of patients, inferior vena cava obstruction in 3 % (1/35), and combined obstruction in 37 % (13/35). The most common risk factor for thrombosis was hyperhomocysteinemia (14/35, 40 %). Recanalization was technically successful in 32 of 35 patients (91 %), and clinically successful in 28 of these 32 patients (88 %). The cumulative 1- and 3-year primary patency rates were 75.2 and 54.3 %, respectively. The cumulative 1- and 3-year secondary patency rates were 89.3 and 89.3 %, respectively. The cumulative 1- and 3-year survival rates were 96.9 and 93.8 %, respectively.ConclusionIn this study, the most common type of lesion was hepatic vein obstruction, the most common thrombotic risk factor was hyperhomocysteinemia, and recanalization resulted in good mid-term outcomes in young Chinese patients with Budd–Chiari syndrome.

  13. 76 FR 52340 - Additional Waiver Granted for the State of New York's CDBG Disaster Recovery Grants-The Drawing...

    Science.gov (United States)

    2011-08-22

    ... for the State of New York's CDBG Disaster Recovery Grants--The Drawing Center AGENCY: Office of the... amount not to exceed $2,000,000, by The Drawing Center, a Lower Manhattan-based nonprofit organization... Grant Disaster Recovery Program. When the space adjacent to The Drawing Center's existing facility...

  14. Disaster recovery plan for Automation Technology

    International Nuclear Information System (INIS)

    Owens, M.J.

    1997-06-01

    Automation Technology provides a multitude of data processing and network services to the Environmental Restoration Contract (ERC). These services include: personal computers, local and wide area networks, and Internet and intranet support and services. ERC employees and client personnel receive these services primarily from the Data Center located on the ground floor in the Bechtel Corporate Center at 3350 George Washington Way, Richland, Washington. Centralized databases, server-based software, and network services for the Bechtel Local Area Network reside on servers located in the Data Center. The data communication circuits supported in this center allow for the transmission of business information to and from all project locations in the Hanford Site complex. The loss of one or more of these functions would seriously impact the ability of the ERC to conduct business and bring a virtual standstill to many ERC employees'' activities. Upon declaration of disaster by the Contingency Manager and the Disaster Recovery Coordinator, the disaster recovery plan will be implemented. 24 tabs

  15. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Disaster Responders Medical Doctors Community Providers and Clergy Co-Occurring Conditions Continuing Education Publications List of Center ... Costs Copays Means Test Health Insurance Make a Payment Annual Income Thresholds Non-VA Care Purchased Care ...

  16. Natural disasters and dialysis care in the Asia-Pacific.

    Science.gov (United States)

    Gray, Nicholas A; Wolley, Martin; Liew, Adrian; Nakayama, Masaaki

    2015-12-01

    The impact of natural disasters on the provision of dialysis services has received increased attention in the last decade following Hurricane Katrina devastating New Orleans in 2005. The Asia-Pacific is particularly vulnerable to earthquakes, tsunami, typhoons (also known as cyclones and hurricanes) or storms and flooding. These events can seriously interrupt provision of haemodialysis with adverse effects for patients including missed dialysis, increased hospitalization and post-traumatic stress disorder. Furthermore, haemodialysis patients may need to relocate and experience prolonged periods of displacement from family and social supports. In contrast to haemodialysis, most literature suggests peritoneal dialysis in a disaster situation is more easily managed and supported. It has become apparent that dialysis units and patients should be prepared for a disaster event and that appropriate planning will result in reduced confusion and adverse outcomes should a disaster occur. Numerous resources are now available to guide dialysis units, patients and staff in preparation for a possible disaster. This article will examine the disaster experiences of dialysis units in the Asia-Pacific, the impact on patients and staff, methods employed to manage during the disaster and suggested plans for reducing the impact of future disasters. © 2015 Asian Pacific Society of Nephrology.

  17. From fatalism to resilience: reducing disaster impacts through systematic investments.

    Science.gov (United States)

    Hill, Harvey; Wiener, John; Warner, Koko

    2012-04-01

    This paper describes a method for reducing the economic risks associated with predictable natural hazards by enhancing the resilience of national infrastructure systems. The three-step generalised framework is described along with examples. Step one establishes economic baseline growth without the disaster impact. Step two characterises economic growth constrained by a disaster. Step three assesses the economy's resilience to the disaster event when it is buffered by alternative resiliency investments. The successful outcome of step three is a disaster-resistant core of infrastructure systems and social capacity more able to maintain the national economy and development post disaster. In addition, the paper considers ways to achieve this goal in data-limited environments. The method provides a methodology to address this challenge via the integration of physical and social data of different spatial scales into macroeconomic models. This supports the disaster risk reduction objectives of governments, donor agencies, and the United Nations International Strategy for Disaster Reduction. © 2012 The Author(s). Disasters © Overseas Development Institute, 2012.

  18. An Examination of the Effectiveness of Public Management Networks (PMNs): Evidence from the Case of the Hurricane Katrina Disaster

    Science.gov (United States)

    Davis, Girte Leah

    2012-01-01

    This dissertation examined the performance outcomes of public management networks (PMNs) in the disaster management context. The effectiveness of three disaster response sub-networks in the area of evacuation were examined and compared using the case of the Hurricane Katrina disaster in New Orleans, Louisiana in August 2005: Citizen Protection:…

  19. Articulating Value and Impact Through Outcome-Centered Service Delivery: the Student and Learning Support Experience at the University of Sunderland.

    OpenAIRE

    Grieves, Kay; Pritchard, Oliver

    2018-01-01

    Purpose- The purpose of this paper is to share the ways in which Student and Learning Support at the University of Sunderland has embedded and matured a new outcome-centered performance model - our Quality Model - in order to create an agile evidence-base of value, outcome and impact evidence. We will also share how, having established the fundamental principles regarding value and impact capture in our library setting, the concepts and approaches have also been developed and applied successf...

  20. Emergency Vehicle Scheduling Problem with Time Utility in Disasters

    Directory of Open Access Journals (Sweden)

    Xiaobing Gan

    2015-01-01

    Full Text Available This paper presents a flexible emergency rescue system which is chiefly composed of three parts, namely, disaster assistance center, relief vehicles, and disaster areas. A novel objective of utility maximization is used to evaluate the entire system in disasters. Considering the uncertain road conditions in the relief distribution, we implement triangular fuzzy number to calculate the vehicle velocity. As a consequence, a fuzzy mathematical model is built to maximize the utility of emergency rescue system and then converted to the crisp counterpart. Finally, the results of numerical experiments obtained by particle swarm optimization (PSO prove the validity of this proposed mathematical model.

  1. Stealth Disasters and Geoethics

    Science.gov (United States)

    Kieffer, Susan W.

    2013-04-01

    Natural processes of the earth unleash energy in ways that are sometimes harmful or, at best, inconvenient, for humans: earthquakes, volcanic eruptions, hurricanes, landslides, floods. Ignoring the biological component of the geosphere, we have historically called such events "natural disasters." They are typically characterized by a sudden onset and relatively immediate consequences. There are many historical examples and our human societies have evolved various ways of coping with them logistically, economically, and psychologically. Preparation, co-existence, recovery, and remediation are possible, at least to some extent, even in the largest of events. Geoethical questions exist in each stage, but the limited local extent of these disasters allows the possibility of discussion and resolution. There are other disasters that involve the natural systems that support us. Rather than being driven primarily by natural non-biological processes, these are driven by human behavior. Examples are climate change, desertification, acidification of the oceans, and compaction and erosion of fertile soils. They typically have more gradual onsets than natural disasters and, because of this, I refer to these as "stealth disasters." Although they are unfolding unnoticed or ignored by many, they are having near-term consequences. At a global scale they are new to human experience. Our efforts at preparation, co-existence, recovery, and remediation lag far behind those that we have in place for natural disasters. Furthermore, these four stages in stealth disaster situations involve many ethical questions that typically must be solved in the context of much larger cultural and social differences than encountered in natural disaster settings. Four core ethical principles may provide guidelines—autonomy, non-maleficence, beneficence, and justice (e.g., Jamais Cascio). Geoscientists can contribute to the solutions in many ways. We can work to ensure that as people take responsibility

  2. Characteristics and Outcomes of Open Globe Trauma in the Urban versus Rural Population: A Single Center Retrospective Review.

    Science.gov (United States)

    Fu, Roxana; Kancherla, Swarupa; Eller, Andrew W; Yu, Jenny Y

    2017-07-05

    To examine the characteristics and outcomes of open globe injuries sustained by the urban population compared to the rural population. This is a retrospective chart review of 429 patients presenting to University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital with traumatic open globes from July 2005 to July 2013. Rural patients had a longer time which elapsed from injury to presentation (P = 0.023, average 12.04 hours vs 7.53 hours). There was a higher incidence of patient transfer prior to arrival to UPMC Presbyterian Hospital (P = 0.018), patient follow-up elsewhere (P = 0.049), and patients sustaining intraocular foreign bodies (IOFBs) (P = 0.009). Health care access is a well-known problem in rural areas and using rural-urban commuting area (RUCA) codes can help identify a population for risk factors or potential disparities in care. Rural patients sustained a higher rate of IOFBs; this should heighten the clinicians' suspicion during the evaluation of an open globe in other rural populations.

  3. A Comparison of Collaborative Care Outcomes in Two Health Care Systems: VA Clinics and Federally Qualified Health Centers.

    Science.gov (United States)

    Grubbs, Kathleen M; Fortney, John C; Pyne, Jeffrey; Mittal, Dinesh; Ray, John; Hudson, Teresa J

    2018-01-16

    Collaborative care for depression results in symptom reduction when compared with usual care. No studies have systematically compared collaborative care outcomes between veterans treated at Veterans Affairs (VA) clinics and civilians treated at publicly funded federally qualified health centers (FQHCs) after controlling for demographic and clinical characteristics. Data from two randomized controlled trials that used a similar collaborative care intervention for depression were combined to conduct post hoc analyses (N=759). The Telemedicine-Enhanced Antidepressant Management intervention was delivered in VA community-based outpatient clinics (CBOCs), and the Outreach Using Telemedicine for Rural Enhanced Access in Community Health intervention was delivered in FQHCs. Multivariate logistic regression was used to determine whether veteran status moderated the effect of the intervention on treatment response (>50% reduction in symptoms). There was a significant main effect for intervention (odds ratio [OR]=5.23, p<.001) and a moderating effect for veteran status, with lower response rates among veterans compared with civilians (OR=.21, p=.01). The addition of variables representing medication dosage and number of mental health and general health appointments did not influence the moderating effect. A sensitivity analysis stratified by gender found a significant moderating effect of veteran status for men but not women. Veteran status was a significant moderator of collaborative care effectiveness for depression, indicating that veterans receiving collaborative care at a CBOC are at risk of nonresponse. Unmeasured patient- or system-level characteristics may contribute to poorer response among veterans.

  4. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study.

    Science.gov (United States)

    Kabbani, Mohamed S; Ismail, Sameh R; Fatima, Anis; Shafi, Rehana; Idris, Julinar A; Mehmood, Akhter; Singh, Reetam K; Elbarabry, Mahmoud; Hijazi, Omar; Hussein, Mohamed A

    2016-01-01

    Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (purinary tract (CAKUT) (purinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  5. Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB-Data Analysis of German Bariatric Surgery Registry.

    Science.gov (United States)

    Stroh, Christine; Köckerling, F; Lange, V; Wolff, S; Knoll, C; Bruns, C; Manger, Th

    2017-02-01

    To examine the association between the certification as bariatric surgery center and volume and patient outcome, data collected in the German Bariatric Surgery Registry were evaluated. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. Data collection began in 2005 for all bariatric procedures in an online database. Participation in the quality assurance study is required for all certified bariatric surgery centers in Germany. Descriptive evaluation and matched pairs analysis were performed. Patients were matched via propensity score taking into account BMI, age, and incidence of comorbidities. During the period from 2005 to 2013, 3083 male and 10,639 female patients were operated on with the RYGB primary approach. In Centers of Competence (77.2 %) and non-accredited hospitals (76.3 %), the proportion of female patients was significantly lower than in Centers of Reference/Excellence (78.7 %; p = 0.002). The mean age in Centers of Reference/Excellence (41.2 years) was significantly lower than in Centers of Competence (43.2 years; p bariatric surgery centers with higher volume. The study supports the concept of certification. There are different factors which can and cannot be preoperatively modified and influence the perioperative outcome.

  6. GIS and environmental disaster management

    International Nuclear Information System (INIS)

    August, P.; Bishop, E.

    1990-01-01

    This paper reports that the Rhode Island Geographic Information System database and the Environmental Data Center, a Geographic Information System (GIS) data processing laboratory at the University of Rhode Island, played an active role in the response to the management of the World Prodigy oil spill in June 1989. During the spill and the cleanup period following the spill, GIS tools were used to record the geographic distribution of oil in Narragansett Bay and Rhode Island Sound. These data were distributed to managers and scientists involved in spill management and analysis. GIS maps were regularly generated for presentations and use in status reports during the week after the spill. Spatial statistics derived from composites of daily oil sheen distributions were used in impact assessment analyses. GIS tools have an important role to play in environmental disaster management, especially those involving the environmental impact assessment of oil spills. The extent to which GIS can be effectively used during the disaster response is largely dependent on how well data systems are pre-adapted to the emergency with respect to data availability and technical preparedness

  7. Children's disaster reactions: the influence of family and social factors.

    Science.gov (United States)

    Pfefferbaum, Betty; Jacobs, Anne K; Houston, J Brian; Griffin, Natalie

    2015-07-01

    This review examines family (demographics, parent reactions and interactions, and parenting style) and social (remote effects, disaster media coverage, exposure to secondary adversities, and social support) factors that influence children's disaster reactions. Lower family socioeconomic status, high parental stress, poor parental coping, contact with media coverage, and exposure to secondary adversities have been associated with adverse outcomes. Social support may provide protection to children in the post-disaster environment though more research is needed to clarify the effects of certain forms of social support. The interaction of the factors described in this review with culture needs further exploration.

  8. Toward to Disaster Mitigation Science

    Science.gov (United States)

    Kaneda, Yoshiyuki; Shiraki, Wataru; Tokozakura, Eiji

    2016-04-01

    Destructive natural disasters such as earthquakes and tsunamis have occurred frequently in the world. For the reduction and mitigation of damages by destructive natural disasters, early detection of natural disasters and speedy and proper evacuations are indispensable. And hardware and software preparations for reduction and mitigation of natural disasters are quite important and significant. Finally, methods on restorations and revivals are necessary after natural disasters. We would like to propose natural disaster mitigation science for early detections, evacuations and restorations against destructive natural disasters. In natural disaster mitigation science, there are lots of research fields such as natural science, engineering, medical treatment, social science and literature/art etc. Especially, natural science, engineering and medical treatment are fundamental research fields for natural disaster mitigation, but social sciences such as sociology, psychology etc. are very important research fields for restorations after natural disasters. We have to progress the natural disaster mitigation science against destructive natural disaster mitigation. in the near future. We will present the details of natural disaster mitigation science.

  9. [Disaster and disaster nursing: from an education and research perspective].

    Science.gov (United States)

    Chen, Li-Chin; Fan, Jun-Yu

    2010-06-01

    Due to its geographic position and the effect of changes in both global and island-specific environments, Taiwan is an area highly prone to natural disasters. While responsibility for national disaster prevention and rescue are distributed amongst various authorities, healthcare agencies hold sole responsibility for the treatment of injuries sustained during disaster events. Disaster casualties require differing levels of medical assistance. In order to respond systematically to disaster events, the government should require that all healthcare facilities operate a hospital emergency incident command system (HEICS). Past experience shows the important role that nurses play in the disaster relief process. The 911 disaster in the United States both helped reorient the direction of nursing education and emphasized teaching practical strategies, standard operating procedures, and frequently asked questions for nurses. Recognizing the limited research done worldwide on disaster nursing, the World Society of Disaster Nursing (WSDN) was established in 2008 in Kobe, Japan. The main purposes of the WSDN is to promote international academic exchange, establish an Internet information exchange platform, and organize international disaster nursing related activities. The WSDN has suggested that future research may focus in on critical issues that include post-disaster health status follow-up, exploration of the healthcare needs and other issues of disaster survivors, care skills development, and the potential for development of cooperative support networks between medical institutions.

  10. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

    Science.gov (United States)

    Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C; Rao, Gullapalli N

    2016-01-01

    To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity gender discrimination in terms of outcome continues to be an issue and needs further investigation.

  11. Disaster Risk Management - The Kenyan Challenge

    Science.gov (United States)

    Nabutola, W.; Scheer, S.

    2009-04-01

    assembly elections Kenya plunged into bloodshed. One Kenyan went for another, people who had been living together as neighbours suddenly turned on one another. Some of the more glaring outcomes were: • About 1,300 Kenyans died. • Property worth billions of shillings was destroyed. • Thousands of Kenyans fled their homes/farms/houses. • To date Kenya has Internally Displaced Persons (IDP). It has become a buzzword, almost fashionable if it were not so sad and grave, and a disgrace to democracy. During the short rains in September and October we experienced floods, land slides, crop failures. Ironically, in the previous months, we had just gone through drought, crops had failed, livestock died, sadly some people died, some through vagaries of weather while others as a result of inter-community friction. The net results were: • Kenya is primarily an agricultural economy sector employs over 80%. Only 20% of the land is arable, the rest is arid and semi arid land, occupied by the nomadic Kenyans. So when there is drought or floods, we get challenges that spark inter-community conflicts. Food shortages lead to higher food prices, a kilogramme bag of maize meal rose from barely affordable Kes. 52.00 to 120.00 in less than two months. In any case the food is not necessarily always available. • The global financial crisis affected our economy very adversely. Fuel prices rose from Kenya Shillings 60.00 per litre to 112.00. • Ironically Kenya's parliament voted against a law that would have compelled them to pay taxes. • As if in anticipation of citizen reactions the MP's passed the media law that would gag freedom of the press. METHODOLOGY 1. Review literature available on disasters in Kenya over the last decades. 2. I will ask Kenyans what they understand by the terms disasters and risks. 3. I will ask the Kenyan authorities - central government and local governments, what plans they have. 4. I will ask Kenya Red Cross what their plans are, their challenges and

  12. Disaster Risk Management - The Kenyan Challenges

    Science.gov (United States)

    Nabutola, W.

    2009-04-01

    assembly elections Kenya plunged into bloodshed. One Kenyan went for another, people who had been living together as neighbours suddenly turned on one another. Some of the more glaring outcomes were: • About 1,300 Kenyans died. • Property worth billions of shillings was destroyed. • Thousands of Kenyans fled their homes/farms/houses. • To date Kenya has Internally Displaced Persons (IDP). It has become a buzzword, almost fashionable if it were not so sad and grave, and a disgrace to democracy. During the short rains in September and October we experienced floods, land slides, crop failures. Ironically, in the previous months, we had just gone through drought, crops had failed, livestock died, sadly some people died, some through vagaries of weather while others as a result of inter-community friction. The net results were: • Kenya is primarily an agricultural economy sector employs over 80%. Only 20% of the land is arable, the rest is arid and semi arid land, occupied by the nomadic Kenyans. So when there is drought or floods, we get challenges that spark inter-community conflicts. Food shortages lead to higher food prices, a kilogramme bag of maize meal rose from barely affordable Kes. 52.00 to 120.00 in less than two months. In any case the food is not necessarily always available. • The global financial crisis affected our economy very adversely. Fuel prices rose from Kenya Shillings 60.00 per litre to 112.00. • Ironically Kenya's parliament voted against a law that would have compelled them to pay taxes. • As if in anticipation of citizen reactions the MP's passed the media law that would gag freedom of the press. METHODOLOGY 1. Review literature available on disasters in Kenya over the last decades. 2. I will ask Kenyans what they understand by the terms disasters and risks. 3. I will ask the Kenyan authorities - central government and local governments, what plans they have. 4. I will ask Kenya Red Cross what their plans are, their challenges and

  13. Reducing Disaster Exacerbated Non-Communicable Diseases Through Public Health Infrastructure Resilience: Perspectives of Australian Disaster Service Providers.

    Science.gov (United States)

    Ryan, Benjamin J; Franklin, Richard C; Burkle, Frederick M; Aitken, Peter; Smith, Erin; Watt, Kerrianne; Leggat, Peter

    2016-12-21

    service infrastructure. Specific measures include: increasing the use of telemedicine; preplanning with medical suppliers; effective town planning; health professionals visiting evacuation centers; evacuation centers having power for medical equipment; hubs for treatment and care after a disaster; evacuation of high risk people prior to disaster; mapping people at risk by non-communicable disease; and a mechanism for sharing information between agencies. A common theme from the participants was that having accurate and easily accessible data on people with non-communicable diseases would allow disaster service providers to adequately prepare for and respond to a disaster. Disaster service providers can play a vital role in reducing the risk of disaster exacerbated non-communicable diseases through public health service infrastructure resilience. They are often employed in communities where disasters occur and are therefore best-placed to lead implementation of the mitigation strategies identified in this research. To sustainably implement the mitigation strategies they will need to become integrated into effective performance and monitoring of the disaster response and health sector during non-disaster periods. For this to occur, the strategies should be integrated into business and strategic plans. Achieving this will help implement the Sendia Framework for Disaster Risk Reduction 2015-2030 and, most importantly, help protect the health of people with non-communicable diseases before, during and after a disaster.

  14. Disaster Debris Recovery Database - Landfills

    Data.gov (United States)

    U.S. Environmental Protection Agency — The US EPA Disaster Debris Recovery Database (DDRD) promotes the proper recovery, recycling, and disposal of disaster debris for emergency responders at the federal,...

  15. Disaster Debris Recovery Database - Recovery

    Data.gov (United States)

    U.S. Environmental Protection Agency — The US EPA Disaster Debris Recovery Database (DDRD) promotes the proper recovery, recycling, and disposal of disaster debris for emergency responders at the federal,...

  16. A Dictionary of Disaster Management

    DEFF Research Database (Denmark)

    Rubin, Olivier; Dahlberg, Rasmus

    A Dictionary of Disaster Management offers over 200 terms covering different disasters from a social science perspective, brining together insights from many different disciplines including sociology, political science, history, anthropology, and natural science. It also features practical terms...

  17. FEMA Historical Disaster Declarations - shp

    Data.gov (United States)

    Department of Homeland Security — The Historical Disaster Declarations provides geospatial view to the Robert T. Stafford Disaster Relief and Emergency Assistance Act (referred to as the Stafford Act...

  18. Liberia national disaster preparedness coordination exercise: Implementing lessons learned from the West African disaster preparedness initiative.

    Science.gov (United States)

    Hamer, Melinda J Morton; Reed, Paul L; Greulich, Jane D; Beadling, Charles W

    2017-01-01

    In light of the recent Ebola outbreak, there is a critical need for effective disaster management systems in Liberia and other West African nations. To this end, the West Africa Disaster Preparedness Initiative held a disaster management exercise in conjunction with the Liberian national government on November 24-25, 2015. During this tabletop exercise (TTX), interactions within and between the 15 counties and the Liberian national government were conducted and observed to refine and validate the county and national standard operating procedures (SOPs). The exercise took place in three regional locations throughout Liberia: Monrovia, Buchanan, and Bong. The TTX format allowed counties to collaborate utilizing open-source software platforms including Ushahidi, Sahana, QGIS, and KoBoCollect. Four hundred sixty-seven individuals (representing all 15 counties of Liberia) identified as key actors involved with emergency operations and disaster preparedness participated in the exercise. A qualitative survey with open-ended questions was administered to exercise participants to determine needed improvements in the disaster management system in Liberia. Key findings from the exercise and survey include the need for emergency management infrastructure to extend to the community level, establishment of a national disaster management agency and emergency operations center, customized local SOPs, ongoing surveillance, a disaster exercise program, and the need for effective data sharing and hazard maps. These regional exercises initiated the process of validating and refining Liberia's national and county-level SOPs. Liberia's participation in this exercise has provided a foundation for advancing its preparedness, response, and recovery capacities and could provide a template for other countries to use.

  19. The effect of electrical stimulation on lumbar spinal fusion in older patients: a randomized, controlled, multi-center trial: part 1: functional outcome.

    Science.gov (United States)

    Andersen, Thomas; Christensen, Finn B; Ernst, Carsten; Fruensgaard, Søren; Østergaard, Jørgen; Andersen, Jens Langer; Rasmussen, Sten; Niedermann, Bent; Høy, Kristian; Helmig, Peter; Holm, Randi; Lindblad, Bent Erling; Hansen, Ebbe Stender; Egund, Niels; Bünger, Cody

    2009-10-01

    Randomized, controlled, multi-center trial. To investigate the effect of direct current (DC) electrical stimulation on functional and clinical outcome after lumbar spinal fusion in patients older than 60 years. Older patients have increased complication rates after spinal fusion surgery. Treatments which have the possibility of enhancing functional outcome and fusion rates without lengthening the procedure could prove beneficial. DC-stimulation of spinal fusion has proven effective in increasing fusion rates in younger and "high risk" patients, but functional outcome measures have not been reported. A randomized, clinical trial comprising 5 orthopedic centers. The study included a total of 107 patients randomized to uninstrumented posterolateral lumbar spinal fusion with or without DC-stimulation. Functional outcome was assessed using Dallas Pain Questionnaire, SF-36, Low Back Pain Rating Scale pain index, and walking distance. Follow-up after 1 year was 95/107 (89%). DC-stimulated patients had significant better outcome in 3 of 4 categories in the Dallas Pain Questionnaire, better SF-36 scores (not significantly), but no difference in pain scores were observed. Median walking distance at latest follow-up was better in the stimulated group (not significant). Walking distance was significantly associated with functional outcome. There was no difference in any of the functional outcome scores between patients who experienced a perioperative complication and those without complications. The achievement of a good functional outcome was heavily dependent on the obtained walking distance. DC-stimulated patients tended to have better functional outcome as compared to controls. No negative effects of perioperative complications could be observed on the short-term functional outcome.

  20. Winged messengers of disaster

    International Nuclear Information System (INIS)

    Medvedev, Z.

    1977-01-01

    The work of the Soviet ecologists, led by A.I. Il'enko, on birds in the southern Urals area, site of the nuclear disaster in 1958, is discussed. The distribution of 90 Sr and 137 Cs in birds, food chains in a large running-water lake, bird migration patterns, and nest conservatism of ducks have been studied. It is pointed out that the existence of migratory species among contaminated species of the southern Urals provides an opportunity for observers in the West to test the truth about the 1958 nuclear disaster in the southern Urals. It is felt that the reports discussed here corroborate the author's original statement that the Urals nuclear disaster involved nuclear waste rather than a major reactor accident. (U.K.)

  1. Disasters as Usual

    DEFF Research Database (Denmark)

    Albris, Kristoffer

    water levels in the Elbe still reached threatening heights on an annual basis, the next sixty years did not produce any flood event that overran the city's flood defences. In hindsight, Dresden experienced what historians of disaster call a disaster memory gap, whereby the collective memory of what....... The recent spate of floods in Dresden prompts us to investigate the nature of the relationship between the ordinary and the exceptional, since events that were once thought to be rare and extraordinary suddenly seem to be more and more frequent. In the thesis, I explore how the citizens of Dresden...... are adjusting to a new understanding of the future in which recurring floods may prove to be the rule rather than the exception. In other words, floods have become what I term usual disasters. The ethnographic research that I conducted in 2014-2015 explores how locals, at this specific moment in time, perceive...

  2. Responses to natural disasters

    Science.gov (United States)

    Maggs, William Ward

    Since 1964, natural disasters caused by earthquakes, volcanic eruptions, or extreme weather in the form of floods, droughts, or hurricanes, have been responsible for more than 2,756,000 deaths worldwide in nations other than the United States, the Soviet Union, and the Eastern European Bloc, according to figures tabulated by the Office of Foreign Disaster Assistance (OFDA) of the Agency for International Development (AID). Over 95% of these fatalities occurred in developing or third world countries. Damage resulting from these calamities has been severe but extremely difficult to estimate in monetary terms. In 1986, U.S. government and voluntary agencies spent $303 million on natural disaster assistance around the world, 79% of total world assistance. In 1985 the U.S. total was nearly $900 million, 48% of the $1.84 billion world total.

  3. Long-term outcome of endoscopic ultrasound-guided pelvic abscess drainage: a two-center series.

    Science.gov (United States)

    Poincloux, Laurent; Caillol, Fabrice; Allimant, Christophe; Bories, Erwan; Pesenti, Christian; Mulliez, Aurélien; Faure, Frederic; Rouquette, Olivier; Dapoigny, Michel; Abergel, Armando; Giovannini, Marc

    2017-05-01

    Background and study aim  Endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported but long-term data remain limited. This two-center study evaluated long-term outcome of EUS-guided pelvic abscess drainage. Patients and methods  Between May 2003 and December 2015, 37 consecutive patients were treated for perirectal or perisigmoid abscesses via EUS-guided drainage using plastic or lumen-apposing metal stent (LAMS). Clinical success was defined as complete resolution of the abscess on follow-up computed tomography (CT) scan at 4 weeks with symptom relief. Long-term success was defined as abscess resolution without the need for surgery and without recurrence on long-term follow-up (> 12 months). Results  Median abscess size was 60 mm (interquartile range 41 - 70). Causes were postsurgical (n = 31, 83.8 %) or secondary to medical conditions (n = 6, 16.2 %). EUS-guided drainage involved needle aspiration (n = 4), plastic stent placement (n = 29) or LAMS placement (n = 4 patients). Technical and clinical success was achieved in 37 patients (100 %; 95 % confidence interval [CI] 91 - 100) and 34 patients (91.9 %; 95 %CI 78 - 98), respectively (5 patients needed a second EUS-guided intervention within 14 days after drainage). One patient required surgery and one required best supportive care owing to persistent abscess. Early complications were perforation requiring surgery (n = 1), stent migration (n = 1), and rectal discomfort (n = 1). At a median follow-up of 64 months (IQR 19 - 81), two patients experienced abscess recurrence, at 3 and 12 months, respectively, and were treated surgically. Long-term success was achieved in 32 of 37 patients (86.5 %; 95 %CI 71 - 95). Conclusion  EUS-guided drainage of pelvic abscess is safe, has good long-term outcome, and should be considered as an alternative to percutaneous and surgical drainage. © Georg Thieme Verlag KG Stuttgart

  4. Disaster Response: Improving Effectiveness

    Science.gov (United States)

    2007-12-01

    Canter . 26 July 2006. 1. 10 Thomas A Garrett and Russell S. Sobel. “The political Economy of FEMA Disaster Payments.” The Federal Bank of St. Louis...and, Brownie, you’re doing a heck of a job. The FEMA Director is working 24…they’re working 24 hours a day.”19 David McEntire highlights the...releases/2005/09/20050902-2.html. Last accessed 9 November 2007. 20 David A. McEntire. Disaster Response and Recovery: Strategies and Tactics for

  5. Reducing natural disaster vulnerability

    Science.gov (United States)

    Zielinski, Sarah

    2006-04-01

    Because poor countries are vulnerable to the impact of natural disasters, the U.K. Department for International Development (DFID) launched on 30 March a new policy to better integrate natural disaster risk reduction into development and humanitarian activities. Gareth Thomas, U.K. development minister, said, ``There is nothing we can do to stop hurricanes, tsunamis, and earthquakes from striking. But what we can do is help put simple measures in place, such as better built houses, schools, and hospitals alongside more high-tech early warning systems to reduce the loss of life.''

  6. Disaster Preparedness in YOUR School.

    Science.gov (United States)

    Texas Education Agency, Austin. Div. of Adult and Continuing Education.

    A look at what to do in time of natural and man-made disasters is presented. Disasters covered include tornados, hurricanes, floods, fires, blizzards, and nuclear disaster. The responsibilities of the Board of Education, school superintendent, school principal, teachers, school nurse, custodian, students, bus drivers, and cafeteria workers are…

  7. Natural disasters and human mobility

    NARCIS (Netherlands)

    Mbaye, L.; Zimmermann, K.

    2016-01-01

    This paper reviews the effect of natural disasters on human mobility or migration. Although there is an increase of natural disasters and migration recently and more patterns to observe, the relationship remains complex. While some authors find that disasters increase migration, others show that

  8. Disaster Education in Australian Schools

    Science.gov (United States)

    Boon, Helen J.; Pagliano, Paul J.

    2014-01-01

    Australia regularly suffers floods, droughts, bushfires and cyclones, which are predicted to increase and/or intensify in the future due to climate change. While school-aged children are among the most vulnerable to natural disasters, they can be empowered through education to prepare for and respond to disasters. School disaster education is…

  9. Replacement of missing posterior tooth with off-center placed single implant: Long-term follow-up outcomes.

    Science.gov (United States)

    Anitua, Eduardo; Murias-Freijo, Alia; Flores, Javier; Alkhraisat, Mohammad Hamdan

    2015-07-01

    The distal offset placement of a single implant to replace a single tooth would overcome the shortcomings of the placement of a single wide implant in the posterior region. However, long-term evaluation is still-lacking. The purpose of this study was to evaluate the long-term outcomes of patients treated with a single tooth restoration supported by a distal-offset placed implant. Thirty-one patients with a single restoration supported by an off-center placed implant were evaluated. The patients' demographic data were described. The known implant length was used as a reference to calibrate the linear measurements on digital periapical radiographs. Implant details, survival, and prosthetic complications were analyzed. The implant survival rate was analyzed with the Kaplan-Meier method. Thirty-four implants were placed with a distal offset to support single-tooth restorations. Twenty patients were women, and patient age was 56 ± 12 years. The implants had a follow-up time from loading up to 10 years (average: 4 ± 3 years). Most of the implants were inserted in type II bone, and 85% were placed in the molar region. The distal offset placement of the implant and the selection of a wide-diameter implant resulted in a mesial bone loss of 0.85 ± 0.57 mm and distal bone loss of 0.83 ± 0.68 mm. One implant failed after 4 months from insertion, resulting in a cumulative survival rate of 97.1%. No prosthetic complications were registered. The distal offset placement of an implant is an efficient option for restoring a single missing posterior tooth when mesiodistal space is limited. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  10. Management of Complications and Outcomes After Revisional Bariatric Surgery: 3-Year Experience at a Bariatric Center of Excellence.

    Science.gov (United States)

    Abdelgawad, Mohamed; De Angelis, Francesco; Iossa, Angelo; Rizzello, Mario; Cavallaro, Giuseppe; Silecchia, Gianfranco

    2016-09-01

    Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process is advocated. In this retrospective study, we reviewed the RBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes. Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundred eighteen patients underwent laparoscopic bariatric procedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n = 77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %). There were no deaths or conversions to open surgery. After a mean follow-up of 22 months, body mass index (BMI) decreased from 40.9 ± 6.7 to 31.9 ± 4.8 kg/m(2), mean % excess weight loss (%EWL) was 58 ± 24.3 %, and 55.3 % of patients had resolution of comorbidities. Eight major complications (10.4 %) occurred: five leaks and three intra-abdominal hematomas. Non-surgical management succeeded in 50 % of complications. This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoided when devoted endoscopists and radiologists are available. Intensive follow-up after complications allows early diagnosis and treatment of unfavorable sequelae. RBS induced a mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable.

  11. Multi-domain patient reported outcomes of irritable bowel syndrome: exploring person centered perspectives to better understand symptom severity scores

    Science.gov (United States)

    Lackner, Jeffrey M.; Jaccard, James; Baum, Charles

    2012-01-01

    Objectives Patient reported outcomes (PRO) assessing multiple gastrointestinal symptoms are central to characterizing the therapeutic benefit of novel agents for irritable bowel syndrome (IBS). Common approaches that sum or average responses across different illness components must be unidimensional and have small unique variances to avoid aggregation bias and misinterpretation of clinical data. This study sought to evaluate the unidimensionality of the IBS Symptom Severity Scale (IBS-SSS) and to explore person centered cluster analytic methods for characterizing multivariate-based patient profiles. Methods Ninety-eight Rome-diagnosed IBS patients completed the IBS-SSS and a single, global item of symptom severity (UCLA Symptom Severity Scale) at pretreatment baseline of an NIH funded clinical trial. A k-means cluster analyses were performed on participants symptom severity scores. Results The IBS-SSS was not unidimensional. Exploratory cluster analyses revealed four common symptom profiles across five items of the IBS-SSS. One cluster of patients (25%) had elevated scores on pain frequency and bowel dissatisfaction, with less elevated but still high scores on life interference and low pain severity ratings. A second cluster (19%) was characterized by intermediate scores on both pain dimensions, but more elevated scores on bowel dissatisfaction. A third cluster (18%) was elevated across all IBS-SSS sub-components. The fourth and most common cluster (37%) had relatively low scores on all dimensions except bowel dissatisfaction and life interference due to IBS symptoms. Conclusions PRO endpoints and research on IBS more generally relying on multicomponent assessments of symptom severity should take into account the multidimensional structure of symptoms to avoid aggregation bias and to optimize the sensitivity of detecting treatment effects. PMID:23337220

  12. Management and outcomes of acute pancreatitis patients over the last decade: A US tertiary-center experience.

    Science.gov (United States)

    Koutroumpakis, Efstratios; Slivka, Adam; Furlan, Alessandro; Dasyam, Anil K; Dudekula, Anwar; Greer, Julia B; Whitcomb, David C; Yadav, Dhiraj; Papachristou, Georgios I

    Acute pancreatitis (AP) management remains largely supportive and can be challenging in patients with severe disease. This study aims to describe a ten-year US tertiary-center experience in managing AP patients. Clinical management and outcomes of 400 prospectively enrolled AP patients stratified by the Revised Atlanta Classification were analyzed; trends in management between early (2004-2008) and late enrollment phase (2009-2014) were assessed. Fifty-two% of patients were classified as mild AP (MAP); moderately severe (MoAP) and severe (SAP) grades contained 23.5% and 24.5% of participants. Intravenous fluid administration during the first 24 h (MAP 3.7, MoAP 4.7, and SAP 4.8 L), need for ICU (6%, 23%, 93%), and nutritional support (7%, 51%, 90%) increased significantly with greater AP severity (p MoAP (p < 0.001). Enteral nutrition (18% vs. 30%) and minimally invasive pancreatic interventions (19% vs. 41%) were more commonly used in the late phase (p < 0.05). The overall median length of hospitalization was 7 days reaching 29 days in SAP group. Mortality was 5%; all deaths occurred in SAP group. This study provides an extensive report on clinical management of AP and its trends overtime. Pancreatic intervention is required in less than 50% of patients with necrotizing pancreatitis. Utilization of enteral nutrition and minimally invasive pancreatic interventions has been increasing over time. Published by Elsevier B.V.

  13. Disaster management: vulnerability and resilience in disaster recovery in Thailand.

    Science.gov (United States)

    Busapathumrong, Pattamaporn

    2013-01-01

    This project explores disaster management in Thailand with a focus on the vulnerability and resilience of women, children, the elderly, and the disabled population and on the impact of disaster on these subpopulations. The 2 main findings deal with the major models of disaster management in Thailand and building resilience for social recovery. The selected 5 major models currently employed in disaster management in Thailand are the (a) model of royal project and international cooperation on disaster preparedness and response, (b) ASEAN Socio-Cultural Blueprint, (c) rights-based approach, (d) welfare mix model, and (e) knowledge management model.

  14. Emerging trends in disaster management and the Ethiopian ...

    African Journals Online (AJOL)

    Emerging trends in disaster management and the Ethiopian experience: genesis, reform and transformation. ... Journal of Business and Administrative Studies ... Key words: disaster management, drought, pre-disaster action, post-disaster action, hazards, disaster, Ethiopian disaster management system, Ethiopia.

  15. Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster – a longitudinal study

    Directory of Open Access Journals (Sweden)

    van den Berg Bellis

    2012-09-01

    Full Text Available Abstract Background Disaster experiences have been associated with higher prevalence rates of (mental health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD. Methods Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1, eighteen months (wave 2 and four years post-disaster (wave 3. Ten years post-disaster (wave 4 the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD. Results Degree of disaster exposure (sum score and some disaster-related experiences (such as house destroyed, injured, confusion were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable ‘house destroyed’ was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster. Conclusions Until 4 years after the disaster, degree of exposure (a sum score was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and

  16. Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster – a longitudinal study

    Science.gov (United States)

    2012-01-01

    Background Disaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD). Methods Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD. Results Degree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable ‘house destroyed’ was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster. Conclusions Until 4 years after the disaster, degree of exposure (a sum score) was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and distress at earlier waves

  17. Disasters in Europe

    OpenAIRE

    Journal Editors

    2000-01-01

    Every year, suddenly, large-scale threats of health or disasters occur across Europe. There are many types of them: explosions, legionellose and other epidemics of infectious diseases, large-scale traffic accidents, unsafe food, and large-scale air pollution.

  18. Disasters in Europe

    Directory of Open Access Journals (Sweden)

    Journal Editors

    2000-11-01

    Full Text Available Every year, suddenly, large-scale threats of health or disasters occur across Europe. There are many types of them: explosions, legionellose and other epidemics of infectious diseases, large-scale traffic accidents, unsafe food, and large-scale air pollution.

  19. Food for Disasters

    Centers for Disease Control (CDC) Podcasts

    2012-07-23

    When disaster strikes, you might not have access to food or water. This podcast discusses types of emergency food supplies you should keep on hand in your emergency kit.  Created: 7/23/2012 by Office of Public Health Preparedness and Response (PHPR).   Date Released: 7/23/2012.

  20. Media framing of natural disasters in Kwazulu-Natal province: Impact of contigency plans

    Directory of Open Access Journals (Sweden)

    Bethuel Sibongiseni Ngcamu

    2015-09-01

    Full Text Available This study explores how the media frame disaster contingency plans which include preparedness, mitigation, response and recovery of the KwaZulu-Natal province before, during and in the aftermath of natural disasters. The province has been stricken by natural disasters. Although newspapers report the disasters they fail to give details of disaster contingency plans that should be available to those who are susceptible to, and the victims of disasters. Based on a content analysis of 114 online newspaper articles between 2000 and 2013 to examine how the media framed the KZN government’s disaster contingency plans. This study concludes that the highest occurrence of disasters (71% was from 2011 onwards as compared to previous years, and most of these were associated with areas that are susceptible to floods (34%. The findings of the study highlight that the media placed an emphasis on disaster response (41% over preparedness (24% and mitigation (7%. The outcomes suggest that newspaper organisations need to appoint a designated reporter responsible for disaster management issues. This is relevant because this study conveys findings that have the potential to persuade government and newspaper organisations to collaborate and to ensure that their officials are multi-skilled and able to cover all phases of disaster management in their articles, in order for these to be understood at all levels of society. This study further adds to the growing body of knowledge regarding quality journalism that meets its objectives.

  1. Virtual Disaster Simulation: Lesson Learned from an International Collaboration That Can Be Leveraged for Disaster Education in Iran.

    Science.gov (United States)

    Ardalan, Ali; Balikuddembe, Joseph Kimuli; Ingrassia, Pier Luigi; Carenzo, Luca; Della Corte, Francesco; Akbarisari, Ali; Djalali, Ahmadreza

    2015-07-13

    Disaster education needs innovative educational methods to be more effective compared to traditional approaches. This can be done by using virtual simulation method. This article presents an experience about using virtual simulation methods to teach health professional on disaster medicine in Iran. The workshop on the "Application of New Technologies in Disaster Management Simulation" was held in Tehran in January 2015. It was co-organized by the Disaster and Emergency Health Academy of Tehran University of Medical Sciences and Emergency and the Research Center in Disaster Medicine and Computer Science applied to Medicine (CRIMEDIM), Università del Piemonte Orientale. Different simulators were used by the participants, who were from the health system and other relevant fields, both inside and outside Iran. As a result of the workshop, all the concerned stakeholders are called on to support this new initiative of incorporating virtual training and exercise simulation in the field of disaster medicine, so that its professionals are endowed with field-based and practical skills in Iran and elsewhere. Virtual simulation technology is recommended to be used in education of disaster management. This requires capacity building of instructors, and provision of technologies. International collaboration can facilitate this process.

  2. Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

    Science.gov (United States)

    Pareja, Rene; Nick, Alpa M; Schmeler, Kathleen M; Frumovitz, Michael; Soliman, Pamela T; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; Reis, Ricardo Dos; Ramirez, Pedro T

    2012-05-01

    To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Competencies for disaster mental health.

    Science.gov (United States)

    King, Richard V; Burkle, Frederick M; Walsh, Lauren E; North, Carol S

    2015-03-01

    Competencies for disaster mental health are essential to domestic and international disaster response capabilities. Numerous consensus-based competency sets for disaster health workers exist, but no prior study identifies and discusses competency sets pertaining specifically to disaster mental health. Relevant competency sets were identified via MEDLINE, PsycINFO, EBSCO, and Google Scholar searches. Sixteen competency sets are discussed, some providing core competencies for all disaster responders and others for specific responder groups within particular professions or specialties. Competency sets specifically for disaster mental health professionals are lacking, with the exception of one set that focused only on cultural competence. The identified competency sets provide guidance for educators in developing disaster mental health curricula and for disaster health workers seeking education and training in disaster mental health. Valid, criterion-based competencies are required to guide selection and training of mental health professionals for the disaster mental health workforce. In developing these competencies, consideration should be given to the requirements of both domestic and international disaster response efforts.

  4. Twelve-month outcomes of serious orthopaedic sport and active recreation-related injuries admitted to Level 1 trauma centers in Melbourne, Australia.

    Science.gov (United States)

    Andrew, Nadine E; Gabbe, Belinda J; Wolfe, Rory; Williamson, Owen D; Richardson, Martin D; Edwards, Elton R; Cameron, Peter A

    2008-09-01

    To describe and identify predictors of 12-month outcomes of serious orthopaedic injuries due to sport and active recreation. Prospective cohort study with 12-month follow-up. Two Level 1 adult trauma centers in Victoria, Australia. A total of 366 adults admitted to two Level 1 trauma centers for an orthopaedic sport and active recreation injury between August 2003 and March 2006. Patients were captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), followed up at 12 months, and were free of moderate to severe disability prior to injury. Independent variables assessed for predictors of outcome were sporting group, age, sex, marital status, education level, Injury Severity Score, injury patterns, and head injury status. The 12-item Short Form Health Survey and maximum pain scores. At 12 months postinjury, 22.8% of patients reported moderate to severe physical disability, 12.1% reported moderate to severe mental health disability, and 11.1% reported moderate to severe pain. There were significant differences in physical outcomes between sporting groups, with motor and equestrian sports reporting the worst physical outcomes. Multivariate analysis indentified increasing age (P = 0.010) and patterns of injury (P = 0.040) as significant predictors of a poor physical outcome at 12 months. No significant independent predictors of outcome for mental health and maximum pain at 12 months were identified. Almost one-quarter of participants reported moderate to severe physical disability at 12 months postinjury. Increasing age and patterns of injury were found to be significant predictors of a poor physical outcome at 12 months.

  5. Medical Rehabilitation in Natural Disasters: A Review.

    Science.gov (United States)

    Khan, Fary; Amatya, Bhasker; Gosney, James; Rathore, Farooq A; Burkle, Frederick M

    2015-09-01

    To present an evidence-based overview of the effectiveness of medical rehabilitation intervention in natural disaster survivors and outcomes that are affected. A literature search was conducted using medical and health science electronic databases (PubMed, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO) up to September 2014. Two independent reviewers selected studies reporting outcomes for natural disaster survivors after medical rehabilitation that addressed functional restoration and participation. Two reviewers independently extracted data and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. A meta-analysis was not possible because of heterogeneity among included trials; therefore, a narrative analysis was performed for best evidence synthesis. Ten studies (2 randomized controlled trials, 8 observational studies) investigated a variety of medical rehabilitation interventions for natural disaster survivors to evaluate best evidence to date. The interventions ranged from comprehensive multidisciplinary rehabilitation to community educational programs. Studies scored low on quality assessment because of methodologic limitations. The findings suggest some evidence for the effectiveness of inpatient rehabilitation in reducing disability and improving participation and quality of life and for community-based rehabilitation for participation. There were no data available for associated costs. The findings highlight the need to incorporate medical rehabilitation into response planning and disaster management for future natural catastrophes. Access to rehabilitation and investment in sustainable infrastructure and education are crucial. More methodologically robust studies are needed to build evidence for rehabilitation programs, cost-effectiveness, and outcome measurement in such settings. Copyright © 2015 American Congress of Rehabilitation Medicine

  6. Information Gap Analysis: near real-time evaluation of disaster response

    Science.gov (United States)

    Girard, Trevor

    2014-05-01

    produced under each category was then compared to establish best practices. Thus, the information produced by a disaster management system following a major disaster can be compared to these best practices within days of the disaster. The resulting "information gap analysis" can help identify areas of the response that may need to be improved and raise questions as to why critical information is lacking or delayed. This information gap analysis therefore complements ex post evaluations and can help lead to improvements in the immediate response and subsequently reduce disaster impacts on the population. The methodology has already been applied in the Center for Disaster Management and Risk Reduction Technology's (CEDIM) Forensic Disaster Analysis (FDA) activities following tropical cyclone Phailin in India, and the Bohol Earthquake and Typhoon Haiyan in the Philippines.

  7. Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms: Radiological Outcome in a Single Center Study.

    Science.gov (United States)

    Kim, Soo Yeon; Park, Dong Sun; Park, Hye Yin; Chun, Young Il; Moon, Chang Taek; Roh, Hong Gee

    2017-11-01

    Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups: simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) ( p =0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) ( p =0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). Use of stents results in good

  8. Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Outcomes from a Multi-Center Study and Risk Factor Analysis in a Single Center.

    Directory of Open Access Journals (Sweden)

    Yadong Zhang

    Full Text Available The aim of this study was to investigate the prevalence of erectile dysfunction (ED in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS and explore the influence of UPOINT domains, National Institutes of Health-CP symptom index (NIH-CPSI and other factors on ED prevalence. This was a prospective study of consecutive patients with CP/CPPS seen at 11 tertiary hospitals during January-July 2014. ED was diagnosed as a score of<21 on the International Index of Erectile Function (IIEF-5. Patients from one center were evaluated by the UPOINT system and NIH-CPSI. Each patient was assessed using clinical examination, asocio-demographic questionnaire, the Patient Health Questionnaire (PHQ, the Pain Catastrophizing Scale (PCS, NIH-CPSI and IIEF-5.1406 patients from 11 centers (mean age, 32.18 years; range 18-60 years were enrolled. ED was found in 638/1406 patients (45.4%, and was categorized as mild in 291(45.6%, moderate in 297(46.6% and severe in50(7.7%. 192 patients from one center(mean age,31.3 years; range 18-57 years were further studied.IIEF-5 score correlated negatively with NIH-CPSI(r = 0.251, PHQ (r = 0.355 and PCS (r = 0.322scores (P<0.001.PHQ score correlated positively with NIH-CPSI (r = 0.586 and PCS(r = 0.662 scores (P<0.001.NIH-CPSI, PHQ, PCS and IIEF-5 scores did not differ significantly between class IIIA and IIIB CP/CPPS. Multivariate logistic regression showed that UPOINT psychological (P domain and NIH-CPSI symptom severity were independent risk factors for ED in CP/CPPS. It is concluded that psychological factors and symptom severity are independent risk factors for ED in CP/CPPS.

  9. Factors Associated with Discussion of Disasters by Final Year High School Students: An International Cross-sectional Survey.

    Science.gov (United States)

    Codreanu, Tudor A; Celenza, Antonio; Alabdulkarim, Ali A Rahman

    2015-08-01

    Introduction The effect on behavioral change of educational programs developed to reduce the community's disaster informational vulnerability is not known. This study describes the relationship of disaster education, age, sex, and country-specific characteristics with students discussing disasters with friends and family, a measure of proactive behavioral change in disaster preparedness. Three thousand eight hundred twenty-nine final year high school students were enrolled in an international, multi-center prospective, cross-sectional study using a pre-validated written questionnaire. In order to obtain information from different educational systems, from countries with different risk of exposure to disasters, and from countries with varied economic development status, students from Bahrain, Croatia, Cyprus, Egypt, Greece, Italy, Portugal, Romania, and Timor-Leste were surveyed. Logistic regression analyses examined the relationship between the likelihood of discussing disasters with friends and family (dependent variable) and a series of independent variables (age, gender, participation in school lessons about disasters, existence of a national disaster educational program, ability to list pertinent example of disasters, country's economic group, and disaster risk index) captured by the questionnaire or available as published data. There was no statistically significant relationship between age, awareness of one's surroundings, planning for the future, and foreseeing consequences of events with discussions about potential hazards and risks with friends and/or family. The national educational budget did not have a statistically significant influence. Participants who lived in a low disaster risk and high income Organization for Economic Co-operation and Development (OECD) country were more likely to discuss disasters. While either school lessons or a national disaster education program had a unique, significant contribution to the model, neither had a better

  10. Adverse Pregnancy Outcomes: Opportunity for Analysis of Biospecimens and Co-development of Prognostics | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Pregnancy and Perinatology Branch seeks partners interested in collaborative research to: (i) evaluate data and samples taken from women for potential biomarkers indicative for adverse pregnancy outcomes and (ii) co-develop diagnostic kits useful as predictors of adverse pregnancy outcomes.

  11. Wars, disasters and kidneys.

    Science.gov (United States)

    Lameire, N

    2014-12-01

    This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.

  12. Disaster prevention surveillance system

    International Nuclear Information System (INIS)

    Nara, Satoru; Kamiya, Eisei

    2001-01-01

    Fuji Electric Co., Ltd. has supplied many management systems to nuclear reactor institution. 'The nuclear countermeasures-against-calamities special-measures' was enforced. A nuclear entrepreneur has devised the measure about expansion prevention and restoration of a calamity while it endeavors after prevention of generating of a nuclear calamity. Our company have supplied the 'disaster prevention surveillance system' to the Japan Atomic Energy Research Institute Tokai Research Establishment aiming at strengthening of the monitoring function at the time (after the accident) of the accident used as one of the above-mentioned measures. A 'disaster prevention surveillance system' can share the information on the accident spot in an on-site command place, an activity headquarters, and support organizations, when the serious accident happens. This system is composed of various sensors (temperature, pressure and radiation), cameras, computers and network. (author)

  13. Translocal disaster interventions:

    DEFF Research Database (Denmark)

    Dalgas, Karina Märcher

    2017-01-01

    The disaster-prone Philippine archipelago is a major point of origin of migrants worldwide. Based on ethnographic fieldwork in the Philippines and Denmark, this article investigates citizens’ responses to the Bohol earthquake of 2013. I examine how individual migrants channel relief...... collective coping mechanisms in a way that complements equality as a principle of distributive justice, while at the same time they contradict the rather different principles of equity. However, on the level of practical implementation, these individual relief channels pose challenges to aspirations...... to provide equal as well as equitable relief. Drawing attention to the practice of excluding the migrants households of origin from the receipt of targeted relief, the article suggests that disaster management should re-consider the assumption that such households are automatically (the sole) recipients...

  14. Using the RE-AIM Framework to Evaluate Disaster Recovery Videos

    Directory of Open Access Journals (Sweden)

    Sarah Cronin

    2018-02-01

    Full Text Available Natural disasters both increase and cause financial challenges for survivors. Crisis support reduces negative outcomes such as financial stress, yet survivors are often unaware or unable to access available services. Aiming to innovatively improve access to quality financial education and to support financial recovery post-disaster, a video series was developed with a community advisory board. The RE-AIM framework informed a developmental evaluation measuring the videos’ influence. Results indicated majority of participants have used or intend to use the videos in their disaster work. This indicates the video series may be a helpful tool for disaster responders when providing financial recovery support.

  15. NCSE's 13th National Conference on Disasters and Environment: Science, Preparedness and Resilience, Post Conference Follow-up Activities and Dissemination

    Energy Technology Data Exchange (ETDEWEB)

    Saundry, Peter [National Council for Science and the Environment, Washington, DC (United States); Johns Hopkins Univ., Baltimore, MD (United States); Kossak, Shelley [National Council for Science and the Environment, Washington, DC (United States)

    2014-04-29

    The National Council for Science and the Environment (NCSE) received $15,000 from the US Department of Energy to support post-conference activities of the 13th National Conference on the theme of Disasters and the Environment: Science, Preparedness and Resilience, held on January 15-17, 2013 at the Ronald Reagan Building and International Trade Center in Washington, DC. Over 1,000 participants from the scientific, emergency response, policy, conservation, and business communities, as well as federal and local government officials, and international entities attended the event. The conference developed actionable outcomes that constructively advance the science behind decision-making on environmental disasters, with an intended result of more prepared and resilient communities in light of a changing climate. Disasters and Environment topic was addressed through six organizing themes: Cascading Disasters; Intersection of the Built and Natural Environments; Disasters as Mechanisms of Ecosystem Change; Rethinking Recovery and Expanding the Vision of Mitigation; Human Behavior and its Consequences; and "No Regrets" Resilience. The program featured eight plenary sessions, 24 symposia and 23 breakout workshops and addressed pivotal issues surrounding disasters and environment including lifeline services, the energy, climate, hazard nexus, grid collapse, community vulnerability, and natural resource management. Sessions, symposia and workshops were conducted by over 200 distinguished thought leaders, scientists, government officials, policy experts and international speakers throughout the three day event. Following the conference, NCSE prepared a set of recommendations and results from the workshops and disseminated the results to universities, organizations and agencies, the business community. NCSE’s national dissemination involved organized several targeted trips and meetings to disseminate significant findings to key stakeholder groups.

  16. Patient Characteristics Predict Occurrence and Outcome of Complaints Against Physicians: A Study From a Medical Center in Central Taiwan

    Directory of Open Access Journals (Sweden)

    Chun-Ying Wu

    2009-02-01

    Conclusion: Patients with certain characteristics tend to file complaints, receive compensation, or bring a case to court. Understanding of patient characteristics may be useful for predicting occurrence and outcome of complaints against physicians.

  17. Methodology identification in mass disasters

    OpenAIRE

    Ampudia García, Omar

    2014-01-01

    Major disasters in Perul ack from a treatment plan and adapt to the current reality. Were rare and limited to natural disasters such as major earthquakes, floods, torrential rains, erupting volcanoes, and so on.At first these disasters were limited to certain geographic areas ingeneral,but with the advancement of science and technology these events have soared alarming lyas rail crashes, plane crashes, car crashes going at high speed,and if we add the attacks by fundamentalist groups with car...

  18. FEMA Disaster Declaration Summary -shp

    Data.gov (United States)

    Department of Homeland Security — This dataset lists all official FEMA Disaster Declarations. This is raw, unedited data from FEMA's National Emergency Management Information System (NEMIS) and as...

  19. FEMA Disaster Declaration Summary - API

    Data.gov (United States)

    Department of Homeland Security — This dataset lists all official FEMA Disaster Declarations. This is raw, unedited data from FEMA's National Emergency Management Information System (NEMIS) and as...

  20. Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating Influence of Human Factor Issues.

    Science.gov (United States)

    Wildenbos, G A; Peute, L W; Jaspers, M W M

    2016-11-10

    To examine the evidence of the impact of patient- centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes. We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention. Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider. While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors' influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes.

  1. Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating Influence of Human Factor Issues

    Science.gov (United States)

    Wildenbos, G.A.; Peute, L.W.

    2016-01-01

    Summary Objectives To examine the evidence of the impact of patient-centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes. Methods We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention. Results Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider. Conclusion While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors’ influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes. PMID:27830238

  2. SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

    Science.gov (United States)

    Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

    2015-01-01

    The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated

  3. 75 FR 21371 - Pennsylvania Disaster #PA-00031

    Science.gov (United States)

    2010-04-23

    ... SMALL BUSINESS ADMINISTRATION [Disaster Declaration 12121 and 12122] Pennsylvania Disaster PA-00031 AGENCY: Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for the Commonwealth of Pennsylvania...

  4. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Section Home PTSD Overview PTSD Basics Return from War Specific to Women Types of Trauma War Terrorism Violence and Abuse Disasters Is it PTSD? ... Combat Veterans & their Families Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning ...

  5. Tsunami disaster risk management capabilities in Greece

    Science.gov (United States)

    Marios Karagiannis, Georgios; Synolakis, Costas

    2015-04-01

    Greece is vulnerable to tsunamis, due to the length of the coastline, its islands and its geographical proximity to the Hellenic Arc, an active subduction zone. Historically, about 10% of all world tsunamis occur in the Mediterranean region. Here we review existing tsunami disaster risk management capabilities in Greece. We analyze capabilities across the disaster management continuum, including prevention, preparedness, response and recovery. Specifically, we focus on issues like legal requirements, stakeholders, hazard mitigation practices, emergency operations plans, public awareness and education, community-based approaches and early-warning systems. Our research is based on a review of existing literature and official documentation, on previous projects, as well as on interviews with civil protection officials in Greece. In terms of tsunami disaster prevention and hazard mitigation, the lack of tsunami inundation maps, except for some areas in Crete, makes it quite difficult to get public support for hazard mitigation practices. Urban and spatial planning tools in Greece allow the planner to take into account hazards and establish buffer zones near hazard areas. However, the application of such ordinances at the local and regional levels is often difficult. Eminent domain is not supported by law and there are no regulatory provisions regarding tax abatement as a disaster prevention tool. Building codes require buildings and other structures to withstand lateral dynamic earthquake loads, but there are no provisions for resistance to impact loading from water born debris Public education about tsunamis has increased during the last half-decade but remains sporadic. In terms of disaster preparedness, Greece does have a National Tsunami Warning Center (NTWC) and is a Member of UNESCO's Tsunami Program for North-eastern Atlantic, the Mediterranean and connected seas (NEAM) region. Several exercises have been organized in the framework of the NEAM Tsunami Warning

  6. Disaster: would your community bounce back?

    Energy Technology Data Exchange (ETDEWEB)

    Sims, Benjamin H [Los Alamos National Laboratory

    2011-01-12

    What makes some communities or organizations able to quickly bounce back from a disaster, while others take a long time to recover? This question has become very important for emergency planners in federal, state, and local government - particularly since the 9/11 attacks and Hurricane Katrina, which nearly destroyed New Orleans five years ago. These events have made people aware that we can't always prevent disasters, but might be able to improve the ability of communities and regions to respond to and bounce back from major disruptions. Social scientists have found that most communities are, in fact, quite resilient to most disasters. People tend to work together, overcome divisions, identify problems, and develop improvised solutions. This often leads to a greater sense of community and a sense of personal accomplishment. Long-term recovery can be harder, but rebuilding can create jobs and stimulate economies. Communities may even end up better than they were before. But there are some disturbing exceptions to this trend, including Hurricane Katrina. The hurricane killed many people, the federal and local emergency response was not effective, people who could not evacuate were housed in the Superdome and Convention Center in terrible conditions, crime was prevalent, and local government did not appear to have control over the situation. A significant portion of the population was eventually evacuated to other cities. Even five years later, many people have not returned, and large parts of the city have not been rebuilt. Clearly, New Orleans lacked sufficient resilience to overcome a disaster of the magnitude of Katrina. There are four factors that social scientists are beginning to agree are important for community resilience: (1) A strong, diverse economy - Stable jobs, good incomes, diversity of industries, personal savings; (2) Robust social networks - Community members know each other, help each other, and have connections outside the community; (3

  7. Disasters And Minimum Health Standards In Disaster Response

    Directory of Open Access Journals (Sweden)

    Sibel GOGEN

    Full Text Available Millions of people are affected by natural or man made disasters all over the world. The number of people affected by disasters increase globally, due to global climate changes, increasing poverty, low life standards, inappropriate infrastructure, lack of early response systems, abuse of natural sources, and beside these, nuclear weapons, wars and conflicts, terrorist actions, migration, displacement and population movements. 95 % of life loss due to disasters are in the underdeveloped or developing countries. Turkey is a developing country, highly affected by disasters. For coping with disasters, not only national action plans, but also International Action Plans and cooperations are needed. Since all the disasters have direct and indirect effects on health, applications of minimal health standarts in disaster response, will reduce the morbidity and mortality rates. In this paper, water supplies and sanitation, vector control, waste control, burial of corpses, nutrition and minimum health standards in disaster response, are reviewed. [TAF Prev Med Bull 2004; 3(12.000: 296-306

  8. 77 FR 67859 - New Jersey Disaster Number NJ-00033

    Science.gov (United States)

    2012-11-14

    .../30/ 2012. Incident: Hurricane Sandy. Incident Period: 10/26/2012 And Continuing. Effective Date: 11..., Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, Tx 76155. FOR FURTHER INFORMATION...., Suite 6050, Washington, DC 20416 SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  9. 76 FR 58329 - New York Disaster Number NY-00108

    Science.gov (United States)

    2011-09-20

    .../ 2011. Incident: Hurricane Irene. Incident Period: 08/26/2011 through 09/05/2011. Effective Date: 09/08... and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  10. 77 FR 67857 - New Jersey Disaster Number NJ-00033

    Science.gov (United States)

    2012-11-14

    .../30/ 2012. Incident: Hurricane Sandy. Incident Period: 10/26/2012 and continuing. Effective Date: 11..., Processing And Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  11. 76 FR 58328 - New York Disaster Number NY-00108

    Science.gov (United States)

    2011-09-20

    .../ 2011. Incident: Hurricane Irene. Incident Period: 08/26/2011 through 09/05/2011. Effective Date: 09/10... and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  12. 77 FR 61650 - Louisiana Disaster Number LA-00048

    Science.gov (United States)

    2012-10-10

    .../31/ 2012. Incident: Hurricane Isaac. Incident Period: 08/26/2012 through 09/10/2012. Effective Date..., Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  13. 77 FR 71666 - New York Disaster Number NY-00130

    Science.gov (United States)

    2012-12-03

    .../ 2012. Incident: Hurricane Sandy. Incident Period: 10/27/2012 through 11/08/2012. Effective Date: 11/19... and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT...., Suite 6050, Washington, DC 20416 SUPPLEMENTARY INFORMATION: The notice of the President's major disaster...

  14. 77 FR 56908 - Louisiana Disaster Number LA-00048

    Science.gov (United States)

    2012-09-14

    .../31/ 2012. Incident: Hurricane Isaac. Incident Period: 08/26/2012 and continuing. Effective Date: 09..., Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION...., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster...

  15. Association of perceived neighborhood characteristics, socioeconomic status and rural residency with health outcomes in Egyptian patients with systemic lupus erythematosus: one center study.

    Science.gov (United States)

    Abdul-Sattar, Amal B; Abou El Magd, Sahar

    2017-12-01

    To investigate the role of perceived neighborhood characteristics, socioeconomic status (SES) and rural residency in influencing the health status outcome of Egyptian patients with systemic lupus erythematosus (SLE). Eighty patients affected with SLE were consecutively included in this a single-center cross-sectional study from July, 2011 to July, 2013. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, the Medical Outcomes Study Short Form-36 Health Survey physical functioning score and Center for Epidemiologic Studies-Depression (CES-D score of ≥ 19 points). Multivariate logistic regression analyses were conducted. Results from multivariate logistic regression analyses, a separate adjusted model of each perceived neighborhood characteristic, indicate associations of worse perceived social cohesion with higher SLAQ scores (P socioeconomic status and rural residency with health status outcomes, the results found association of poor socioeconomic status with the three health status outcome measures and association between rural residency and depression symptoms. Individuals had increased odds of depressive symptoms if they perceived worse neighborhood social cohesion (odds ratio [OR]: 2.14; CI: 1.42-2.80), if they perceived worse neighborhood safety (OR: 1.64; CI: 1.02-2.40) and if they perceived worse neighborhood aesthetic characteristics (OR: 2.79; CI: 1.84-3.38). Study findings indicate that poor socioeconomic status, rural residency and perceived neighborhood characteristics are associated with depression; worse perceived neighborhood aesthetics and safety are associated with lower SF-36 physical functioning, and worse neighborhood social cohesion is associated with higher disease activity among patients with SLE. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  16. Do specialized centers and specialists produce better outcomes for patients with chronic diseases than primary care generalists? A systematic review.

    NARCIS (Netherlands)

    Post, P.N.; Wittenberg, J.; Burgers, J.S.

    2009-01-01

    PURPOSE: Although specialized centers are generally accepted for treatment of relatively uncommon diseases, such as cystic fibrosis, statements regarding the amount of expertise or minimum number of patients treated are increasingly included in guidelines for the treatment of other chronic diseases

  17. Effects of Home Environment and Center-Based Child Care Quality on Children's Language, Communication, and Literacy Outcomes

    Science.gov (United States)

    Pinto, Ana Isabel; Pessanha, Manuela; Aguiar, Cecilia

    2013-01-01

    This study examined the joint effects of home environment and center-based child care quality on children's language, communication, and early literacy development, while also considering prior developmental level. Participants were 95 children (46 boys), assessed as toddlers (mean age = 26.33 months; Time 1) and preschoolers (mean age = 68.71…

  18. Hazagora: will you survive the next disaster? - A serious game to raise awareness about geohazards and disaster risk reduction

    Science.gov (United States)

    Mossoux, S.; Delcamp, A.; Poppe, S.; Michellier, C.; Canters, F.; Kervyn, M.

    2016-01-01

    Natural disasters are too often presented as resulting from extreme natural phenomena affecting helpless populations, with people being insufficiently aware of the factors leading to disasters and of the existing strategies to mitigate their impacts. We developed a board game aimed at raising awareness about geohazards and disaster risk reduction strategies. The target groups are (1) secondary school students and citizens and (2) scientists and stakeholders involved in risk management activities. For the first group, the aim is to induce a better understanding of the geohazards and disasters they are confronted with in the media or in their daily lives; for the second, the objective is to generate discussion about risk management strategies. The game was tested with students in Belgium and with citizens, earth scientists, and risk managers in several African countries. Based on analysis of the most common game strategies observed, the players' reactions during the game, and their answers to a short questionnaire, we analyzed the main learning outcomes conveyed by this game. The game Hazagora appears to positively enhance the players' insights into processes involved in disasters. As such, the game is an effective, fun learning tool to introduce participants to the concepts of geohazards and disasters and to generate discussion.

  19. Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

    Directory of Open Access Journals (Sweden)

    Seth Messinger

    2017-11-01

    Full Text Available Objective: To explore how the social context of the clinic influenced the way former patients with lower limb loss in the Military Advanced Training Center at Walter Reed National Military Medical Center evaluated their outcomes. Design: Cross-sectional phenomenological-based interviews and observations. Patients: Twenty individuals with lower limb amputation were recruited from a multidisciplinary military treatment programme for patients with lower-extremity traumatic limb-loss injured in Afghanistan or Iraq. Methods: Lightly structured interviews were conducted either in person or over the telephone with former patients and clinical care-providers. Where possible, observation was conducted in conjunction with the interviews. The research team used content analysis of the data, consistent with ethnographic methods. Results: Analysis of the therapeutic effect of social relationships developed in the clinical rehabilitation programme identified 3 areas of significance: enduring relationships with key care-providers, access to treatment team by patients, and peer support among patients. Conclusion: The social component of service delivery influences patients’ outcomes from clinical care. These results could be translated across healthcare settings to improve patient outcomes.

  20. Methods and impact of engagement in research, from theory to practice and back again: early findings from the Patient-Centered Outcomes Research Institute.

    Science.gov (United States)

    Forsythe, Laura; Heckert, Andrea; Margolis, Mary Kay; Schrandt, Suzanne; Frank, Lori

    2018-01-01

    Since 2012, PCORI has been funding patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders in the research, a requirement that is unique among the US funders of clinical research. This paper presents PCORI's evaluation framework for assessing the short- and long-term impacts of engagement; describes engagement in PCORI projects (types of stakeholders engaged, when in the research process they are engaged and how they are engaged, contributions of their engagement); and identifies the effects of engagement on study design, processes, and outcomes selection, as reported by both PCORI-funded investigators and patient and other stakeholder research partners. Detailed quantitative and qualitative information collected annually from investigators and their partners was analyzed via descriptive statistics and cross-sectional qualitative content and thematic analysis, and compared against the outcomes expected from the evaluation framework and its underlying conceptual model. The data support the role of engaged research partners in refinements to the research questions, selection of interventions to compare, choice of study outcomes and how they are measured, contributions to strategies for recruitment, and ensuring studies are patient-centered. The evaluation framework and the underlying conceptual model are supported by results to date. PCORI will continue to assess the effects of engagement as the funded projects progress toward completion, dissemination, and uptake into clinical decision making.

  1. Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

    Science.gov (United States)

    Hoying, Cheryl; Farra, Sharon; Mainous, Rosalie; Baute, Rebecca; Gneuhs, Matthew

    2017-02-01

    An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations.

  2. Risk and Disaster Management: From Planning and Expertise to Smart, Intelligent, and Adaptive Systems.

    Science.gov (United States)

    Benis, Arriel; Notea, Amos; Barkan, Refael

    2018-01-01

    "Disaster" means some surprising and misfortunate event. Its definition is broad and relates to complex environments. Medical Informatics approaches, methodologies and systems are used as a part of Disaster and Emergency Management systems. At the Holon Institute of Technology - HIT, Israel, in 2016 a National R&D Center: AFRAN was established to study the disaster's reduction aspects. The Center's designation is to investigate and produce new approaches, methodologies and to offer recommendations in the fields of disaster mitigation, preparedness, response and recovery and to disseminate disaster's knowledge. Adjoint to the Center a "Smart, Intelligent, and Adaptive Systems" laboratory (SIAS) was established with the goal to study the applications of Information and Communication Technologies (ICT) and Artificial Intelligence (AI) to Risk and Disaster Management (RDM). In this paper, we are redefining the concept of Disaster, pointing-out how ICT, AI, in the Big Data era, are central players in the RDM game. In addition we show the merit of the Center and lab combination to the benefit of the performed research projects.

  3. Gene expression signatures predict outcome in non-muscle invasive bladder carcinoma - a multi-center validation study

    DEFF Research Database (Denmark)

    Andersen, Lars Dyrskjøt; Zieger, Karsten; Real, Francisco X.

    2007-01-01

    PURPOSE: Clinically useful molecular markers predicting the clinical course of patients diagnosed with non-muscle-invasive bladder cancer are needed to improve treatment outcome. Here, we validated four previously reported gene expression signatures for molecular diagnosis of disease stage and ca...

  4. Center-size as a predictor of weight-loss outcome in multicenter trials including a low-calorie diet

    DEFF Research Database (Denmark)

    Gasteyger, Christoph Rolf; Christensen, Robin; Larsen, Thomas Meinert

    2010-01-01

    weight loss. This is a post hoc analysis of an existing database: 701 obese subjects (77% women, 23% men, mean BMI: 38.9 kg/m(2)) were enrolled at 22 sites (4-85 subjects/site) in five countries to follow a LCD providing 800-1,000 kcal/day during 8 weeks. The main outcome measure was the percentage...

  5. Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center

    DEFF Research Database (Denmark)

    Lutz, J; Holtmannspötter, M; Flatz, W

    2016-01-01

    PURPOSE: Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent male individuals. METHODS: We performed a retrospective study to determine the efficacy and safety of preoperative embolization and the surgical outcome in...

  6. The obstetric outcome following treatment in a cohort of patients with antiphospholipid antibody syndrome in a tertiary care center

    Directory of Open Access Journals (Sweden)

    V Dadhwal

    2011-01-01

    Full Text Available Background: Antiphospholipid antibody syndrome (APAS is regarded as the most frequently acquired risk factor for thrombophilia. The obstetric manifestations of APAS include early or late pregnancy losses and complications like preeclampsia and fetal growth restriction. Its timely diagnosis and treatment can improve maternal and neonatal outcome. Aims: To study the pregnancy outcome of patients with APAS treated with heparin and aspirin. Settings and Design: This was a retrospective study of pregnancy outcome in 42 consecutive women with APAS, treated with heparin and aspirin. Materials and Methods: The case records of 42 diagnosed cases of APAS with pregnancy, over a 3-year period, were studied. The pregnancy outcome in this group was compared before and after treatment with heparin and low-dose aspirin in terms of abortions, intrauterine deaths and live birth rate. The outcome of the present pregnancy in terms of fetal and maternal complications was analyzed. Results: The mean age and average parity of women with APAS were 30.1±4.1 years and 3.2±1.2, respectively. Among the treated patients of APAS, 13 (30.9% had preeclampsia and 9 (21.4% had intrauterine growth restriction (IUGR. There were 2 (4.7% intrauterine deaths, 4 (9.5% missed abortions and 3 (7.1% abruptio placentae. Women with APAS had a live birth rate of 4.6% before treatment and 85.7% in the index pregnancy after treatment. Conclusion: Treatment of pregnant women with APAS results in marked improvement in the live birth rate (4.6-85.7%. However, complications like preeclampsia and IUGR occur even after treatment, requiring strict monitoring and timely delivery.

  7. Longitudinal health effects of disasters.

    NARCIS (Netherlands)

    Yzermans, C.J.

    2004-01-01

    Background: We carry out prospective, longitudinal studies on the possible health effects of two disasters in the Netherlands: the explosion of fireworks depot in a residential area (Enschede) and a fire in discotheque in Volendam. Learning from the chaotic aftermath previous disasters, the Dutch

  8. Disaster: Prevention, Preparedness and Action.

    Science.gov (United States)

    Buchanan, Sally

    1981-01-01

    Discission of threat of disaster to library archival materials focuses on prevention (building maintenance, materials storage, fire prevention), preparedness (preplanning, procedures for handling emergencies, finances of recovery operation), and action (instructions for handling damaged materials). Current library activities in disaster planning…

  9. Assessing Hospital Disaster Readiness Over Time at the US Department of Veterans Affairs.

    Science.gov (United States)

    Der-Martirosian, Claudia; Radcliff, Tiffany A; Gable, Alicia R; Riopelle, Deborah; Hagigi, Farhad A; Brewster, Pete; Dobalian, Aram

    2017-02-01

    Introduction There have been numerous initiatives by government and private organizations to help hospitals become better prepared for major disasters and public health emergencies. This study reports on efforts by the US Department of Veterans Affairs (VA), Veterans Health Administration, Office of Emergency Management's (OEM) Comprehensive Emergency Management Program (CEMP) to assess the readiness of VA Medical Centers (VAMCs) across the nation. Hypothesis/Problem This study conducts descriptive analyses of preparedness assessments of VAMCs and examines change in hospital readiness over time. To assess change, quantitative analyses of data from two phases of preparedness assessments (Phase I: 2008-2010; Phase II: 2011-2013) at 137 VAMCs were conducted using 61 unique capabilities assessed during the two phases. The initial five-point Likert-like scale used to rate each capability was collapsed into a dichotomous variable: "not-developed=0" versus "developed=1." To describe changes in preparedness over time, four new categories were created from the Phase I and Phase II dichotomous variables: (1) rated developed in both phases; (2) rated not-developed in Phase I but rated developed in Phase II; (3) rated not-developed in both phases; and (4) rated developed in Phase I but rated not- developed in Phase II. From a total of 61 unique emergency preparedness capabilities, 33 items achieved the desired outcome - they were rated either "developed in both phases" or "became developed" in Phase II for at least 80% of VAMCs. For 14 items, 70%-80% of VAMCs achieved the desired outcome. The remaining 14 items were identified as "low-performing" capabilities, defined as less than 70% of VAMCs achieved the desired outcome. Measuring emergency management capabilities is a necessary first step to improving those capabilities. Furthermore, assessing hospital readiness over time and creating robust hospital readiness assessment tools can help hospitals make informed decisions

  10. Improved Outcomes Following Hepatocellular Carcinoma (HCC) Diagnosis in Patients Screened for HCC in a Large Academic Liver Center versus Patients Identified in the Community.

    Science.gov (United States)

    Okoronkwo, Nneoma; Wang, Yucai; Pitchumoni, Capecomorin; Koneru, Baburao; Pyrsopoulos, Nikolaos

    2017-03-28

    Background and Aims: Hepatocellular carcinoma (HCC) is the sixth most commonly occurring cancer worldwide. Knowledge and adherence to HCC surveillance guidelines has been associated with earlier detection. We sought to evaluate characteristics and outcomes following HCC diagnosis in patients screened for HCC in a large academic liver center versus patients diagnosed and referred from the community. Methods : We reviewed the records of patients diagnosed with HCC in the liver center of an academic institution from January 1999 till December 2013. Patients were classified into two groups: patients followed in our hepatology clinic and patients with HCC recently referred to our center. Univariate analysis was performed using chi-squared test and multivariate analysis was performed using SPSS 22.0. Results: The records of 410 patients were reviewed, and included 77.3% of patients referred from the community and 22.7% of patients followed in our clinic. In the clinic group, 75.6% were identified with one nodule at initial diagnosis, compared to 65.6% in the referral group. Patients in the referral group were more likely to present with tumors ≥5 cm at diagnosis, with 28.7% compared to 5.4% in the clinic group ( p HCC diagnosis and are more likely to meet the Milan criteria and undergo transplant. Early referral to a specialized transplant center, if feasible, where a multidisciplinary approach is utilized might be essential in the management of chronic liver disease.

  11. Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia.

    Science.gov (United States)

    Alghnam, Suliman; Alkelya, Muhamad; Alfraidy, Moath; Al-Bedah, Khalid; Albabtain, Ibrahim Tawfiq; Alshenqeety, Omar

    2017-01-01

    Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia. To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system. Retrospective, analytical. Trauma center of a tertiary care center in Riyadh. The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods. Injury severity score (ISS), Glasgow coma scale (GCS) and mortality. The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant. This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs. The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.

  12. Disaster Preparedness in Philippine Nurses.

    Science.gov (United States)

    Labrague, Leodoro J; Yboa, Begonia C; McEnroe-Petitte, Denise M; Lobrino, Ledwin R; Brennan, Mary Geronima B

    2016-01-01

    This study examined the perceived level of disaster preparedness in Philippine nurses. A descriptive, cross-sectional research design was used in this study. Two hundred nurses were invited to participate in the study, with 170 responses (105 hospital nurses and 65 community nurses) or an 85% response rate, during the months of April 2014 through July 2014. Data collection was based on interviews using a standardized instrument, the Disaster Preparedness Questionnaire. Descriptive statistics such as frequencies, means, percentages, and standard deviations were utilized to quantify the responses. Three fourths of the respondents (n = 136, 80%) indicated that they were not fully prepared to respond to disasters, while only 20% (n = 34) acknowledged that they felt they were adequately prepared. Respondents believed that they could function in the primary roles of educator (n = 107, 62.94%), caregiver (n = 104, 61.17%), and counselor (n = 82, 48.24%). More than half of the respondents (n = 98, 57.7%) were not aware of existing protocols of disaster management in the workplace. Courses taken in such areas as first aid (n = 79, 46.4%), field triage (n = 43, 25.29%), and basic cardiac life support (n = 57, 33.53%) were cited as important in preparing for disasters. Nurses in the study revealed that they were not sufficiently prepared for disasters nor were they aware of disaster management protocols in the workplace. Hospital administrators should consider the development and formulation of disaster management protocols and provide appropriate disaster nursing education and training. Nursing curricula should incorporate basic principles of disaster management into nursing courses as a framework for addressing this critical deficit. © 2015 Sigma Theta Tau International.

  13. The Etiology of Improved Outcomes at High Volume Centers Learning Theory and the Case of Implant Flashing.

    Science.gov (United States)

    Bookman, Jared; Duffey, Romney; Hutzler, Lorraine; Slover, James; Iorio, Richard; Bosco, Joseph

    2016-06-01

    Increased volume has been shown to be associated with improved outcomes for many orthopaedic procedures. For individual surgeons, the concepts of learning curves and volume effects have been well established in the literature. For institutions, high-volume hospitals have also been shown to have better outcomes for orthopaedic procedures such as total joint replacements. However, exactly how hospital volume mediates this improvement is not well understood. Learning theory states that learning occurs as a result of accumulated experience, not based on time. We compared our institution's curve representing our implant flashing rates to other institutional data sets that exhibit learning and continuous quality improvement, including airline near misses, coal mining accidents, and others. Development of expertise is based on volume and rate of errors, and therefore higher volume is conducive to faster learning.

  14. Atypical presentation and outcome of cervicogenic headache in patients with cervical degenerative disease: A single-center experience.

    Science.gov (United States)

    Bir, Shyamal C; Nanda, Anil; Patra, Devi Prasad; Maiti, Tanmoy Kumar; Liendo, Cesar; Minagar, Alireza; Chernyshev, Oleg Y

    2017-08-01

    Cervicogenic headache affects a significant portion of the entire population. This type of headache especially with atypical presentation is often hard to diagnose and manage since its etiopathophysiology is not been yet well understood. We have investigated the prevalence of cervicogenic headache with atypical presentation and discussed the etiology of it, and the outcome of surgical intervention on this type of headache in patients with cervical degenerative disease. Radiological and clinical data of 160 patients (from 2001 through 2016) were retrospectively reviewed. Significant differences between the groups were determined by chi-square test. Logistic regression analysis was performed to identify the predictors of unfavorable outcome. In this study, 10% of the patients had atypical presentation of cervicogenic headache. In overall cohort, after surgical intervention, there was significant improvement in symptoms and pain control, whether the presentation is typical or atypical. Sixty-one percent of the patients had no complaints, and 90% of the patients were headache-free (ppresentation of headache (90.1%) compared to group with atypical (80%) presentation, p=0.04. In this study, female gender, smoking, obesity and depression were identified as predictors of overall unfavourable outcome. In addition, in a separate analysis, smoking and depression were revealed as risk factors for persistent headache. A notable portion of patients with cervicogenic headache can have an atypical presentation mimicking a primary type headache. However, cervicogenic headaches with atypical presentation can be difficult to diagnose and manage at the initial visit of the patients. Etiopathophysiology of this type of headache could be explained by the theories including discogenic, convergence and sensitization-desensitization theories. When cervicogenic headache is accompanied with CDD, performing ACDF or laminectomy would be the treatment of choice. Surgical intervention can also

  15. Outcomes of dialysis catheters placed by the Y-TEC peritoneoscopic technique: a single-center surgical experience.

    Science.gov (United States)

    Al Azzi, Yorg; Zeldis, Etti; Nadkarni, Girish N; Schanzer, Harry; Uribarri, Jaime

    2016-02-01

    In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.

  16. A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia

    Directory of Open Access Journals (Sweden)

    Jason R Kovac

    2014-01-01

    Full Text Available Introduction: Obstructive azoospermia (OA is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization (IVF combined with PESA in cases of men with OA. Aims: To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens. Materials and Methods: The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years (2002-2010 were retrospectively reviewed. Patients requiring testicular intervention were excluded ( n = 17. Results: Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients (78.4% simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer (12.5%. Pregnancies were confirmed in 48.6% (17/35. Twin gestations occurred in 11.8% (2/17 of cases. Frozen-thawed spermatozoa were used in 11 patients (21.6%. In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% (6/11. No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens. Summary: PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process.

  17. Real-world antithrombotic therapies and clinical outcomes after second-generation drug-eluting stent implantation in patients with atrial fibrillation: a multi-center cohort study.

    Science.gov (United States)

    Otsuki, Hisao; Yamaguchi, Junichi; Kamishima, Kazuho; Arashi, Hiroyuki; Hagiwara, Nobuhisa

    2018-03-16

    Previous reports have focused on cardiovascular and bleeding events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, antithrombotic treatment strategies and clinical outcomes after second-generation drug-eluting stents (DES) implantation in AF patients remain to be determined. We enrolled 244 consecutive AF patients treated with second-generation DES. The study population was derived from multi-center AF registry (including 8 centers in Japan) from 2010 to 2012. Prescription of antithrombotic agents and clinical outcomes were retrospectively examined. Ninety-two patients (37.7%) were prescribed dual antiplatelet therapy (DAPT) at discharge and 152 patients (62.3%) were given DAPT plus oral anticoagulation (OAC) with warfarin. The median follow-up period was 730 days. Kaplan-Meier analysis showed that major adverse cardiac and cerebrovascular events (MACCE) were not significantly different (2-year event rate, 17.6 vs. 13.5%, p = 0.37), but bleeding events were significantly higher in the DAPT plus OAC group than in the DAPT group (2-year event rate, 6.1 vs. 17.9%, p = 0.033). In a sub-analysis of DAPT plus OAC patients, adequate time in the therapeutic range (TTR) group (TTR ≥ 65%) was not significantly different from the suboptimal OAC group (TTR < 65%) for bleeding events, but it had a lower incidence of MACCE, resulting in better net clinical outcomes (composite of MACCE and major bleeding, 2-year event rate, 9.2 vs. 27.8%, p = 0.008). DAPT plus OAC remains more common in AF patients undergoing PCI with second-generation DES. Under adequate TTR, DAPT plus OAC showed better net clinical outcomes by reducing MACCE without increasing bleeding.

  18. [Therapeutic outcomes of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection: Cohort of Kabinda Center in Kinshasa, Democratic Republic of Congo].

    Science.gov (United States)

    Akilimali, P Z; Tshilumbu, J M K; Mavila, A K; Kaba, D K

    2015-12-01

    The study aimed to determine the clinical forms of tuberculosis and therapeutic outcome of anti-tuberculosis treatment in the context of HIV-tuberculosis co-infection. A retrospective cohort of 120 HIV-positive patients with tuberculosis and 297 HIV-negative patients with tuberculosis attending the Kabinda Center was followed from 2010 to June, 30th 2013. The logistic regression model identified the determinants of a defavorable outcome after initiation of tuberculostatics. The proportion of female patients was higher in the co-infected group compared with the non-co-infected group (60.8% versus 42.7%, P<0.001). HIV-seropositive patients had more forms of pulmonary smear-negative (39.2% versus 25.3%, P<0.002) and extra-pulmonary (38% versus 35%, P<0.002) tuberculosis than HIV-negative patients. HIV-positive serology (OR: 3.13, 95%CI: 1.72-5.69) and age of patients more than 41 years (OR: 3.15, 95%CI: 1.36-7.29) were associated with an unfavorable outcome. This study highlights the usefulness of a systematically determining immunological status in co-infected patients and a timely and systematic ARV treatment, together with early diagnosis of tuberculosis. It also emphasizes the importance of adherence to support measures in order to improve tuberculosis treatment outcomes in co-infected patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Treatment outcomes of pulpotomy in permanent molars with irreversible pulpitis using biomaterials: a multi-center randomized controlled trial.

    Science.gov (United States)

    Asgary, Saeed; Eghbal, Mohammad Jafar

    2013-01-01

    To conduct a randomized clinical trial to compare the post-operative pain experience as well as clinical and radiographic outcomes of pulpotomy in human permanent molars with irreversible pulpitis using calcium enriched mixture (CEM) cement or mineral trioxide aggregate (MTA). A total of 413 patients met the inclusion criteria and consented to participate. The patients were randomly allocated into two study arms: MTA pulpotomy (PMTA: n = 208) and CEM pulpotomy (PCEM: n = 205). Numerical rating scale questionnaires were utilized by the patients to record pain intensity (PI) over 7 days post-operatively. The patients were followed-up for 12 months to assess the clinical and radiographic outcomes of treatment. The data was analyzed using Chi-square, Cohen's kappa and t-tests. There was no significant difference in the mean PI recorded during the 7 post-operative days between the two study arms (p = 0.221). The clinical and radiographic success rates for PMTA at 12-month follow-up were 98 and 95%, respectively; and 97 and 92% for PCEM, respectively. There was no significant differences in clinical (p = 0.7) and radiographic (p = 0.4) success rates between the two arms. Excellent treatment outcomes occurred in molar teeth with irreversible pulpitis undergoing pulpotomy with MTA and CEM biomaterials.

  20. Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Mohammad Al Barqi

    2015-12-01

    Full Text Available To describe the clinical features, systemic associations, treatment and visual outcomes in Saudi patients with scleritis. A retrospective chart review was performed for patients with scleritis presenting to two tertiary care eye hospitals in Riyadh, Saudi Arabia, from 2001 to 2011. Data were collected on the clinical features of scleritis, subtypes of scleritis, associated systemic disease, history of previous ocular surgery and medical therapy, including the use of immunosuppressants. Treatment outcomes were evaluated based on best-corrected visual acuity (BCVA and response to treatment. Of the 52 patients included in the study, non-necrotizing anterior scleritis was the most common type of scleritis in 22 patients (42.3%, followed by posterior scleritis in 14 patients (26.9%. The majority of cases, 31 patients (59.6%, were idiopathic in nature. Systemic associations were present in 12 patients (23.1%. Infectious scleritis was confirmed in 6 patients (11.5%: 3 with bacterial scleritis after pterygium excision, 2 patients with scleritis related to tuberculosis and 1 patient with scleritis resulting from herpes simplex infection. For the various subtypes of scleritis, BCVA values after treatment and time to remission significantly differed (P Non-necrotizing anterior scleritis was the most common subtype of scleritis. Final visual outcome and time to remission differed among the various scleritis subtypes.

  1. Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center.

    Science.gov (United States)

    Erfani, Hadi; Kassir, Elias; Fox, Karin A; Clark, Steven L; Karbasian, Niloofar; Salmanian, Bahram; Shamshirsaz, Amir A; Espinoza, Jimmy; Nassr, Ahmed A; Eppes, Catherine S; Belfort, Michael A; Shamshirsaz, Alireza A

    2017-11-05

    The objective of this study is to compare patient outcomes between planned and emergent cesarean deliveries for placenta previa without morbidly adherent placenta. All patients with confirmed, persistent placenta previa (without morbidly adherent placentation) who underwent the surgery between January 2010 and April 2016 were included in this retrospective study. Primary outcome was composite maternal morbidity defined as the presence of at least one of the followings: death, red blood cell (RBC) transfusion, hysterectomy, reoperation, hospital stay >7 d, ureteral injury, bowel injury, or cystotomy. Three hundred and four patients with placenta previa were identified during the study period, of whom 154 (50.65%) had an antenatal and 10 (3.28%) had an intraoperative diagnosis of morbidly adherent placenta. One hundred and forty patients met the inclusion criteria. Eighty (57.1%) underwent planned cesarean delivery (planned cesarean delivery (PCD) group), and 60 (42.8%) required emergent cesarean delivery due to uterine contractions and/or bleeding (emergent cesarean delivery (ECD) group). Baseline characteristics were similar between the two groups except for the gestational age at delivery (36.0 weeks (36.0, 37.0) in PCD versus 34.0 weeks (32.0, 36.0) in ECP, p placenta previa without morbidly adherent placenta have similar maternal outcomes. In patients without significant hemorrhage, delivery may be safely deferred until 36-37 weeks.

  2. Clinical outcomes of laparoscopic surgery for advanced transverse and descending colon cancer: a single-center experience.

    Science.gov (United States)

    Yamamoto, Masashi; Okuda, Junji; Tanaka, Keitaro; Kondo, Keisaku; Tanigawa, Nobuhiko; Uchiyama, Kazuhisa

    2012-06-01

    The role of laparoscopic surgery in management of transverse and descending colon cancer remains controversial. The aim of the present study is to investigate the short-term and oncologic long-term outcomes associated with laparoscopic surgery for transverse and descending colon cancer. This cohort study analyzed 245 patients (stage II disease, n = 70; stage III disease, n = 63) who underwent resection of transverse and descending colon cancers, including 200 laparoscopic surgeries (LAC) and 45 conventional open surgeries (OC) from December 1996 to December 2010. Short-term and oncologic long-term outcomes were recorded. The operative time was longer in the LAC group than in the OC group. However, intraoperative blood loss was significantly lower and postoperative recovery time was significantly shorter in the LAC group than in the OC group. The 5-year overall and disease-free survival rates for patients with stage II were 84.9% and 84.9% in the OC group and 93.7% and 90.0% in the LAC group, respectively. The 5-year overall and disease-free survival rates for patients with stage III disease were 63.4% and 54.6% in the OC group and 66.7% and 56.9% in the LAC group, respectively. Use of laparoscopic surgery resulted in acceptable short-term and oncologic outcomes in patients with advanced transverse and descending colon cancer.

  3. Efficacy of phototherapy devices and outcomes among extremely low birth weight infants: multi-center observational study

    Science.gov (United States)

    Morris, BH; Tyson, JE; Stevenson, DK; Oh, W; Phelps, DL; O’Shea, TM; McDavid, GE; Van Meurs, KP; Vohr, BR; Grisby, C; Yao, Q; Kandefer, S; Wallace, D; Higgins, RD

    2013-01-01

    Objective Evaluate the efficacy of phototherapy (PT) devices and the outcomes of extremely premature infants treated with those devices. Study Design This substudy of the National Institute of Child Health and Human Development Neonatal Research Network PT trial included 1404 infants treated with a single type of PT device during the first 24±12 h of treatment. The absolute (primary outcome) and relative decrease in total serum bilirubin (TSB) and other measures were evaluated. For infants treated with one PT type during the 2-week intervention period (n =1223), adjusted outcomes at discharge and 18 to 22 months corrected age were determined. Result In the first 24 h, the adjusted absolute (mean (±s.d.)) and relative (%) decrease in TSB (mg dl−1) were: light-emitting diodes (LEDs) −2.2 (±3), −22%; Spotlights −1.7 (±2), −19%; Banks −1.3 (±3), −8%; Blankets −0.8 (±3), −1%; (PLEDs achieved the greatest initial absolute reduction in TSB but were similar to Spots in the other performance measures. Long-term effects of PT devices in extremely premature infants deserve rigorous evaluation. PMID:22499082

  4. Disaster and Sociolegal Studies

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    Susan Sterett

    2013-04-01

    Full Text Available Disasters are treated as independent events external to law. However, social processes define the beginning, end and extent of those events for mitigation, adaptation and response and recovery; those processes include the mobilization of law by people and organizations. Within the sociology of disaster, it is tempting to treat law as a problem-solving tool. Sociolegal analysis approaches law more skeptically: legal actors face problems and defer to the decisions others have made, or discount future problems as much as other institutions do and thereby contribute to problems, or offer compensation that does not ameliorate the inequality within and among countries that disaster can exacerbate. Law can signal that it is doing something about problems via national or supranational rights; for it actually to help requires legal actors to mobilize. Finally, the site of law has been displaced: from law being within public authority enacted through institutions to law as a matter of individual, self-governance set in expectation of disaster, and humanitarian assistance done through non-governmental organizations. This collection contributes analyses of individuals and organizations' action in disaster through legal processes. Los desastres se tratan como hechos independientes externos al derecho. Sin embargo, los procesos sociales definen el principio, el final y el alcance de esos acontecimientos en lo que respecta a su mitigación, adaptación, respuesta y recuperación; esos procesos incluyen la movilización del derecho por personas y organizaciones. En el ámbito de la sociología de los desastres, es tentador tratar el derecho como una herramienta para la resolución de problemas. Sin embargo, los análisis sociojurídicos se aproximan al derecho de forma más escéptica: los actores legales se enfrentan a problemas y se adhieren a decisiones que otros han tomado, o descartan problemas futuros de la misma forma que otras instituciones, aumentando

  5. Disaster event: Window of opportunity to implement global disaster policies?

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    Siambabala B. Manyena

    2013-10-01

    Full Text Available Disasters have been predominantly construed as destructive events causing loss of lives, livelihoods and hard-won development. Much less attention has been paid to the constructive nature of disasters as creating potential windows of opportunities to address the overlooked and neglected aspects of disaster risk reduction. Using material from Zimbabwe, this article examines whether the humanitarian crisis, as manifested in the cholera disaster of 2008–2009, created a window of opportunity to accelerate the implementation of the Hyogo Framework for Action. The findings suggest that the humanitarian crisis did not necessarily create a window of opportunity to accelerate the implementation of the framework, owing to (1 inadequate authority and power of the agency responsible for disaster risk reduction, (2 an inadequate legal and institutional framework that outlines clear coordination, accountability mechanisms, resource mobilisation, community participation, and integration of development with regard to disaster risk reduction and (3 a lack of an integrated evidence-based approach to advocate disaster risk reduction in Zimbabwe.

  6. Disaster event: Window of opportunity to implement global disaster policies?

    Directory of Open Access Journals (Sweden)

    Siambabala B. Manyena

    2013-03-01

    Full Text Available Disasters have been predominantly construed as destructive events causing loss of lives, livelihoods and hard-won development. Much less attention has been paid to the constructive nature of disasters as creating potential windows of opportunities to address the overlooked and neglected aspects of disaster risk reduction. Using material from Zimbabwe, this article examines whether the humanitarian crisis, as manifested in the cholera disaster of 2008–2009, created a window of opportunity to accelerate the implementation of the Hyogo Framework for Action. The findings suggest that the humanitarian crisis did not necessarily create a window of opportunity to accelerate the implementation of the framework, owing to (1 inadequate authority and power of the agency responsible for disaster risk reduction, (2 an inadequate legal and institutional framework that outlines clear coordination, accountability mechanisms, resource mobilisation, community participation, and integration of development with regard to disaster risk reduction and (3 a lack of an integrated evidence-based approach to advocate disaster risk reduction in Zimbabwe.

  7. Using mixed methods to assess pediatric disaster preparedness in the hospital setting.

    Science.gov (United States)

    Burke, Rita V; Kim, Tae Y; Bachman, Shellby L; Iverson, Ellen I; Berg, Bridget M

    2014-12-01

    Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims. The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims. A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center. Exercise participants provided quantitative and qualitative feedback regarding their perceptions of pediatric disaster response during the exercise in the form of surveys and interviews. Additionally, trained observers provided qualitative feedback and recommendations regarding aspects of emergency response during the exercise, including communication, equipment and supplies, pediatric safety, security, and training. According to quantitative participant feedback, the disaster exercise enhanced respondents' perceived preparedness to care for the pediatric population during a mass-casualty event. Further, qualitative feedback from exercise participants and observers revealed opportunities to improve multiple aspects of emergency response, such as communication, equipment availability, and physician participation. Additionally, participants and observers reported opportunities to improve safety and security of children, understanding of staff roles and responsibilities, and implementation of disaster triage exercises. Consistent with previous investigations of pediatric disaster preparedness, evaluation of the exercise revealed several opportunities for all hospitals to improve their ability to respond to the needs of pediatric victims. Quantitative and qualitative feedback from both participants and observers was useful for comprehensively assessing the exercise's successes and obstacles. The present study has

  8. Perceived Ability to Practice in Disaster Management among Public Health Nurses in Aceh, Indonesia

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    Ardia Putra

    2011-07-01

    Full Text Available Background: The increasing number of disaster events around the world has challenged every country to develop better disaster-management strategies. As a part of healthcare system, public health nurses (PHNs should be involved in caring for people in disasters. Currently, there is no known study whether PHNs of Aceh, Indonesia, working with community people who are at high risk of confronting natural disasters, are able to perform their roles and functions regarding disaster management. Methods: 252 PHNs from twenty-seven public health centers in Aceh were studied during November to December 2010 to evaluate their perceived ability to practice regarding disaster management at each disaster phase: preparedness, response, and recovery phase. The perceived ability to practice was assessed by using the 30-statement, five-point Likert-scale (0-4 of Public Health Nurses’ Perceived Ability to Practice Regarding Disaster Management Questionnaire (PHNPP-DMQ. The composite scores of each phase and the total score were calculated and transformed to percentage for ease of presentation across disaster phases.Results: Overall, the PHNs’ perceived ability to practice regarding disaster management in Aceh was at a moderate level (M=74.57%, SD=13.27. The highest mean score was for the recovery phase (M=78%, and the lowest mean score was in the preparedness phase (66.15%.Conclusion: The finding of this study evokes challenges to the local government of Aceh province to further prepare PHNs to increase their ability in disaster management.Keywords: Disaster management, practice, public health nurses

  9. Impact of surgical experience on management and outcome of pancreatic surgery performed in high- and low-volume centers.

    Science.gov (United States)

    Stella, Marco; Bissolati, Massimiliano; Gentile, Daniele; Arriciati, Alessandro

    2017-09-01

    Pancreaticoduodenectomy (PD) is one of the procedures in general surgery with the highest rate of life-threatening complications. The positive impact of the volume-outcome ratio on outcomes and mortality in pancreatic surgery (PS) has led to policy-level efforts toward centralization of care for PS that is currently under evaluation by some Regional Health Services. The role of the surgeon's experience and training is still under debate. The aim of this paper is to compare the outcomes of PS by the same surgeon in a high volume (HV) and in a low volume (LV) hospital to assess whether a specific training in PS could outdo the benefits of hospital volume. 124 pancreatic resections (98 PD) were conducted by a single surgeon from 2004 to 2014 in two different Italian hospitals with different PS volumes as well as in general surgical activities. The results were retrospectively analyzed. All data regarding demographics, oncological characteristics, surgical parameters and post-operative outcomes were compared between patients operated on in the HV (group A) and LV hospital (group B). The surgical experience in the LV hospital has been then divided into a first period (group B1) and in a second period (group B2). χ 2 test or Fisher's exact test (when variables were dichotomous) was used. The unpaired t test was used to compare continuous data between the two groups. Values are expressed as n. of cases (percent) for categorical data or as mean (standard deviation) for continuous data. A p value less than 0.05 was considered as significant. From 2004 to 2014, 124 patients underwent pancreatic resection by the same surgeon: 69 in an HV hospital (group A) and 55 in an LV hospital (group B). We focused our attention on PD outcomes, 54 in group A and 44 in group B (22 in group B1 and 22 in group B2, accordingly to the aforementioned criteria). A higher incidence of ASA 3 patients, although not statistically significant, was found in group B than in group A (34 vs. 18%; p

  10. The impact of natural disasters on child health and investments in rural India.

    Science.gov (United States)

    Datar, Ashlesha; Liu, Jenny; Linnemayr, Sebastian; Stecher, Chad

    2013-01-01

    There is growing concern that climate change will lead to more frequent natural disasters that may adversely affect short- and long-term health outcomes in developing countries. Prior research has primarily focused on the impact of single, large disaster events but very little is known about how small and moderate disasters, which are more typical, affect population health. In this paper, we present one of the first investigations of the impact of small and moderate disasters on childhood morbidity, physical growth, and immunizations by combining household data on over 80,000 children from three waves of the Indian National Family and Health Survey with an international database of natural disasters (EM-DAT). We find that exposure to a natural disaster in the past month increases the likelihood of acute illnesses such as diarrhea, fever, and acute respiratory illness in children under 5 year by 9-18%. Exposure to a disaster in the past year reduces height-for-age and weight-for-age z-scores by 0.12-0.15 units, increases the likelihood of stunting and underweight by 7%, and reduces the likelihood of having full age-appropriate immunization coverage by nearly 18%. We also find that disasters' effects vary significantly by gender, age, and socioeconomic characteristics. Most notably, the adverse effects on growth outcomes are much smaller among boys, infants, and families with more socioeconomic resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Outcome Evaluation of a Policy-Mandated Lifestyle and Environmental Modification Program in a National Job Training Center.

    Science.gov (United States)

    Jimenez, Elizabeth Yakes; Harris, Amanda; Luna, Donald; Velasquez, Daniel; Slovik, Jonathan; Kong, Alberta

    2017-06-01

    Excess weight gain is common when adolescents become young adults, but there are no obesity prevention or weight management interventions that have been tested for emerging adults who follow non-traditional post-secondary paths, such as enrolling in job training programs. We evaluated Healthy Eating & Active Lifestyles (HEALs), a policy-mandated lifestyle education/environmental modification program, at a job training center for low-income 16-24 year olds. We examined average change in body mass index (BMI) z-score from baseline to 6 months for emerging adults (aged 16-24 years) in pre-HEALs implementation (n = 125) and post-HEALs implementation (n = 126) cohorts living at the job training center, by baseline weight status. In both cohorts, average BMI z-score significantly increased from baseline to 6 months for students with BMI < 25. Average BMI z-score significantly decreased for the overweight (BMI 25 to <30; -0.11, p = .03) and obese (BMI ≥ 30; -0.11, p = .001) students only within the post-HEALs cohort; changes within the pre-HEALs cohort and between cohorts were not significant. HEALs may promote positive weight-related trends for overweight/obese students, but prevention efforts for non-overweight/obese students need to be improved.

  12. Wilms’ Tumor: Histopathological Variants and the Outcomes of 31 Cases at a Tertiary Care Center in Northern India

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    Kamal Nain Rattan

    2017-07-01

    Full Text Available Background: Wilms’ tumor is the most common malignant renal tumor in the pediatric age group. This tumor is classically managed by multimodal treatment which involves surgery, radiotherapy and chemotherapy. While there is plenty of data in world literature on the outcome of Wilms’ tumor, there is a paucity of data from India. Methods: All patients with proven diagnosis of Wilms’ tumor between 2008 to 2012 were noted from the hospital’s cancer registry. We performed detailed analyses of all patients’ clinical case records for demographic profiles, clinical features, imaging studies, treatment, and outcome. Histopathological classification of the tumor determined the patient’s post-operative management. All patients were followed for a period of 3 years and we analyzed the eventual outcome in the form of disease-free survival, complications, tumor recurrence, and mortality. Results: There were 31 cases of Wilms’ tumor included in this study. The median age of presentation was 3-4 years (range: 5 months-6 years with a female: male ratio of 1.2:1. Abdominal mass was the chief presenting feature in 20 (64.5% patients followed by abdominal pain in 6 (19.3%. All children had unilateral disease, 25 (80.6% had right-sided and 6 (19.3% had left-sided disease. Bilateral disease was seen in only one case. Of the 31 cases of Wilms’ tumor, 36% cases presented with stages I and II disease, 55% had stage III, and 9% of the cases were stage IV. Most cases of Wilms’ tumor were stage III. The majority had classical Wilms’ tumor with a favourable histology. The estimated 5-year event free survival was 87.3% Conclusion: A multidisciplinary approach can approach similar survival rates compared to the National Wilms’ Tumor Study Group, even in the Indian scenario. Further improvement in survival of these children can only be achieved by increasing awareness, early recognition, appropriate referral, and a multidisciplinary approach.

  13. Clinical Profi le and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience.

    Science.gov (United States)

    Cuenza, Lucky R; Manapat, Normita; Jalique, Jundelle Romulo K

    2016-10-01

    Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifi cally in Filipino patients. Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables. The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3. 16 patients had an initial EF of 25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months. Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.

  14. Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia.

    Science.gov (United States)

    Al Barqi, Mohammad; Behrens, Ashley; Alfawaz, Abdullah M

    2015-01-01

    To describe the clinical features, systemic associations, treatment and visual outcomes in Saudi patients with scleritis. A retrospective chart review was performed for patients with scleritis presenting to two tertiary care eye hospitals in Riyadh, Saudi Arabia, from 2001 to 2011. Data were collected on the clinical features of scleritis, subtypes of scleritis, associated systemic disease, history of previous ocular surgery and medical therapy, including the use of immunosuppressants. Treatment outcomes were evaluated based on best-corrected visual acuity (BCVA) and response to treatment. Of the 52 patients included in the study, non-necrotizing anterior scleritis was the most common type of scleritis in 22 patients (42.3%), followed by posterior scleritis in 14 patients (26.9%). The majority of cases, 31 patients (59.6%), were idiopathic in nature. Systemic associations were present in 12 patients (23.1%). Infectious scleritis was confirmed in 6 patients (11.5%): 3 with bacterial scleritis after pterygium excision, 2 patients with scleritis related to tuberculosis and 1 patient with scleritis resulting from herpes simplex infection. For the various subtypes of scleritis, BCVA values after treatment and time to remission significantly differed (P<0.05, all cases). Systemic immunosuppressive therapies in addition to steroids were administered to 46.2% of all patients. The T-sign was present on B-scan ultrasonography in 9 (64.3%) of the 14 posterior scleritis patients. Non-necrotizing anterior scleritis was the most common subtype of scleritis. Final visual outcome and time to remission differed among the various scleritis subtypes.

  15. Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

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    Ying Song

    Full Text Available The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs after stent assisted coiling (SAC has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years. The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months. Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be

  16. Status of Thyroid Peroxidase Antibodies in Pregnant Women and Association with Obstetric and Perinatal Outcomes in Tertiary Care Center

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    Karuna

    2017-10-01

    Full Text Available Introduction: Thyroid dysfunction is reported in 8.25% of pregnant women in Indian subcontinent. About two thirds of these women have subclinical hypothyroidism and the rest have overt hypothyroidism. Aim: To study the prevalence and impact of Thyroid Peroxidase (TPO antibodies on obstetric and perinatal outcome in a tertiary health centre. Materials and Methods: This was a prospective cohort study conducted in antenatal clinic of Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry at King George Medical University, Lucknow, India. Total 230 antenatal women upto 20 weeks of gestational age were recruited, venous blood sample was assessed for serum TSH and TPO Ab and women were classified as subclinical or overt hypothyroid. Subsequently, serum TSH was repeated at interval of 4-6 weeks after initiation of treatment. All the enrolled women were followed for obstetric and perinatal outcome. Results: The prevalence of TPO Ab in pregnant women was 49 (21.3%. The proportion of hypothyroid women was higher in TPO positive group as compared to TPO negative group (48.98% V/s 27.22%, p=0.01. There were 10 abortions, 4 of them had TPO Ab V/s 6 who were TPO Ab negative. Among TPO Ab positive hypothyroid women 37.5% had preterm labour Vs 5.26% in TPO Ab positive euthyroid women (p-value=0.04. GDM was observed more in TPO Ab positive group (14.2% vs 7.56% p=0.157. There was no difference in terms of caesarean section or neonatal outcome in the study. Conclusion: The study shows the high prevalence (21.3% of TPO antibody in antenatal women. Hypothyroidism was more prevalent in TPO Ab positive group. Preterm labour was seen more often in hypothyroid women with TPO Ab.

  17. 76 FR 70368 - Disaster Designation Process

    Science.gov (United States)

    2011-11-14

    ... Service Rural Utilities Service 7 CFR Parts 759, 1945 and 762 RIN 0560-AH17 Disaster Designation Process... severe drought situations, and change the USDA Secretarial disaster designation process from six steps to... programs such as crop disaster payment programs. The current disaster designation process is set out in 7...

  18. Disasters, Victimization, and Children's Mental Health

    Science.gov (United States)

    Becker-Blease, Kathryn A.; Turner, Heather A.; Finkelhor, David

    2010-01-01

    In a representative sample of 2,030 U.S. children aged 2-17, 13.9% report lifetime exposure to disaster, and 4.1% report experiencing a disaster in the past year. Disaster exposure was associated with some forms of victimization and adversity. Victimization was associated with depression among 2- to 9-year-old disaster survivors, and with…

  19. Impact of Pretransplantation Indices in Hematopoietic Stem Cell Transplantation: Knowledge of Center-Specific Outcome Data Is Pivotal before Making Index-Based Decisions.

    Science.gov (United States)

    Törlén, Johan; Remberger, Mats; Le Blanc, Katarina; Ljungman, Per; Mattsson, Jonas

    2017-04-01

    Outcome after allogeneic hematopoietic stem cell transplantation is influenced by patient comorbidity, disease type, and status before treatment. We performed a retrospective study involving 521 consecutive adult hematopoietic stem cell transplantation patients who underwent transplantation for hematological malignancy at our center from 2000 to 2012 to compare the predictive value of the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) and the disease risk index (DRI) for overall survival and transplantation-related mortality. Patients in the highest HCT-CI risk group (HCT-CI score ≥3) had a lower 5-year overall survival rate (50%) than the low-risk group (63%; P 6 [n = 9]). Five-year overall survival in the highest DRI risk group was significantly poorer (44%) than in the low-risk group (63%; P indices failed to predict differences in transplantation-related mortality (HCT-CI, P = .54; DRI, P = .17). We conclude that HCT-CI and DRI were predictive of overall survival in our patient population. Even so, our data show that different patient groups may have different outcomes despite sharing the same index risk group and that indices should, therefore, be evaluated according to local data before clinical implementation at the single-center level. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  20. Educating the Psychology Workforce in the Age of the Affordable Care Act: A Graduate Course Modeled after the Priorities of the Patient-Centered Outcomes Research Institute (PCORI)

    Science.gov (United States)

    Hoerger, Michael

    2015-01-01

    The Affordable Care Act (ACA) represents a paradigm shift in the U.S. healthcare system, which has implications for psychology programs producing the next generation of trainees. In particular, the ACA has established the Patient-Centered Outcomes Research Institute (PCORI), which has been tasked with developing national priorities and funding research aimed at improving healthcare quality by helping patients and providers to make informed healthcare decisions. PCORI's national priorities span five broad domains: person-centered outcomes research, health disparities research, healthcare systems research, communication and dissemination research, and methodologic research. As these national priorities overlap with the knowledge and skills often emphasized in psychology training programs, initiatives by training programs to bolster strengths in these domains could place trainees at the forefront of this emerging research paradigm. As a part of a new Masters program in behavioral health, our program developed a health psychology course modeled around PCORI's five national priorities, and an initial evaluation in a small sample supported student learning in the five PCORI domains. In summary, the current report has implications for familiarizing readers with PCORI's national priorities for U.S. healthcare, stimulating debate surrounding psychology's response to the largest healthcare paradigm shift in recent U.S. history, and providing a working model for programs seeking to implement PCORI-related changes to their curricula. PMID:26843899

  1. Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

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    Mitsides N

    2016-07-01

    Full Text Available Nicos Mitsides,1,2 Sandip Mitra,1,2 Tom Cornelis3 1Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, 2National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK; 3Department of Nephrology, Jessa Hospital, Hasselt, Belgium Abstract: Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist. Keywords: hemodialysis, home dialysis, high dose, outcomes

  2. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

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    Sumathi Matta

    Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9

  3. Nonprofit Organizations in Disaster Response and Management: A Network Analysis

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    NAIM KAPUCU

    2018-01-01

    Full Text Available This paper tracks changes in the national disaster management system with regard to the nonprofit sector by looking at the roles ascribed to nonprofit organizations in the Federal Response Plan (FRP, National Response Plan (NRP, and National Response Framework (NRF. Additionally, the data collected from news reports and organizational after action reports about the inter-organizational interactions of emergency management agencies during the September 11th attacks and Hurricane Katrina are analyzed by using network analysis tools. The findings of the study indicate that there has been an increase in the interactions of the National Voluntary Organizations Active in Disasters (NVOAD network member organizations on par with policy changes in the NRP to involve nonprofit organizations in the national disaster planning process. In addition, those organizations close to the center of the network experienced enhanced communication and resource acquisition allowing them to successfully accomplish their missions, a finding that supports the development of strong network connections.

  4. Effect of Young Maternal Age on Obstetric and Perinatal Outcomes: Results from the Tertiary Center in Turkey

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    Oya Demirci

    2016-06-01

    Full Text Available Background: Young maternal age is variously defined in studies of its effect on obstetrics and perinatal outcomes. Also, pregnancy has been reported as the leading cause of death in adolescent girls in low- and middle-income countries. Aims: The aim of the study was to evaluate whether young maternal age was associated with an increased risk of obstetrics and perinatal adverse outcomes. Study Design: Case-control study. Methods: This case-control study was derived from a database of the medical records between January 2008 and December 2012. In the present study, 1374 teenage pregnancy and 1294 adult pregnancy cases were included. After restriction of analyses to singleton primiparous women, 1282 teenage pregnancy and 735 adult pregnancy cases were analyzed. Maternal age was separated into three groups: 15 and less, 16-19, and 20-34 years. Adjusted odds ratios (ORs were derived through logistic regression models for the potential confounding factors. Results: Adolescents aged 15 years and younger had higher risks of preterm delivery, early preterm delivery, intrauterine fetal death and neonatal death compared with women aged 20 to 34 years after adjustment for confounding factors. In addition, both groups of adolescents had higher risks for anemia and episiotomy and lower risk of cesarean delivery. The rates of preeclampsia, gestational diabetes, chronic diseases, intrauterine growth restriction (IUGR were higher in the adult group. Conclusion: Younger maternal age was correlated with increased risks of preterm delivery, fetal and neonatal death and anemia.

  5. Presentation and outcome of eclampsia at a tertiary center in South East Nigeria--a 6-year review.

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    Eke, Ahizechukwu Chigoziem; Ezebialu, Ifeanyichukwu Uzoma; Okafor, Charles

    2011-01-01

    To determine the maternal and fetal outcomes of eclamptic patients treated in Nnamdi Azikiwe University Teaching Hospital, Nnewi, over a 6-year period (2004-2009). It was a retrospective study. The case notes of 212 patients with eclampsia were analyzed with respect to age, parity, type of eclampsia, gestational age, booking status, mode of delivery, and outcome of the babies and mothers. There were 212 cases of eclampsia out of a total of 13,536 deliveries, giving a prevalence of 1.57%. One hundred and sixty (24.5%) of the women were unbooked. Antepartum eclampsia constituted 160 (75.5%) of all types of eclampsia. Nulliparous teenagers were the most commonly affected women--128 (60.4%). Cesarean delivery was higher than vaginal delivery, accounting for 160 (75.5%) of all deliveries. There was a statistically significant relationship between the route of delivery and the parity of the women (χ(2) = 3.60; d = 5; p = 0.035). There were 16 maternal deaths, giving a case fatality rate of 7.5%. There were 12 neonatal and 8 perinatal deaths. Puerperal sepsis occurred in 9.4% of the patients. Eclampsia is a major cause of maternal mortality in Nnewi, rural South East Nigeria. Teenage nulliparous women are most susceptible.